Detailed Answer
Under Kansas law, workers’ compensation carriers must pay for all reasonable and necessary medical treatment related to a work injury. See K.S.A. 44-510k (fee schedule for medical services) and K.S.A. 44-551 (payment of compensation). To confirm that your workers’ compensation insurer applied payments to your medical bills, follow these steps:
Step 1: Request Itemized Medical Bills
Contact each health care provider who treated your work injury. Ask for an itemized statement showing all charges and payments posted to your account. Most providers issue bills monthly or after each visit.
Step 2: Obtain Explanation of Benefits (EOB) from the Insurer
Submit a written request to your workers’ compensation insurer or adjuster asking for copies of all Explanation of Benefits (EOBs) or payment vouchers related to your medical treatment. Kansas law requires carriers to furnish copies upon request. Keep records of your request and the date you mailed or emailed it.
Step 3: Compare Billed Amounts to Insurer Payments
Line-by-line, compare the provider’s itemized charges with the insurer’s EOB payments. Confirm that the net amounts listed on each bill match the net payments on your EOBs. Note any discrepancies, such as unpaid balances or partial credits.
Step 4: Verify Write-Offs and Patient Balances
Under K.S.A. 44-510k, carriers must follow the Kansas Medical Fee Schedule when reimbursing providers. If your provider writes off a balance under the fee schedule, verify with the provider’s billing office that the write-off was accepted from the carrier and not billed to you.
Step 5: Follow Up on Outstanding Balances
If you identify unpaid charges that should have been covered, contact the adjuster and provider billing office. Provide copies of the itemized bill and EOB. Request written confirmation showing how payments were applied.
Step 6: Seek a Formal Review if Needed
If the carrier or provider will not resolve discrepancies, you can file a petition with the Kansas Division of Workers Compensation for a hearing. Under K.S.A. 44-551, the Workers’ Compensation Board can order carriers to pay overdue medical bills and may impose penalties for late payment.
Disclaimer
This article is for informational purposes only. It does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.
Helpful Hints
- Keep a dedicated file for medical bills, EOBs, and correspondence.
- Send requests for EOBs by certified mail and retain delivery receipts.
- Ask providers for billing codes and fee schedule references to cross-check with K.S.A. 44-510k.
- Note response deadlines: carriers must pay undisputed bills within 30 days of receipt.
- If you hit a dead end, contact the Kansas Department of Labor Workers’ Compensation division for guidance.