GQ Corner
Q. I have a medical provider that continues billing the patient and now is in collections. The carrier has attempted to change the insurance and we have sent back the bills requesting proper billing. Is there a rule that addresses a medical provider billing a patient?
A. Rule 133. 20 addresses medical bill submission by health care provider. Specifically, Rule 133.20 (k) states, “A health care provider shall not submit a medical bill to an injured employee for all or part of the charge for any of the health care provided, except as an informational copy clearly indicated on the bill, or in accordance with subsection (l) of this section. The information copy shall not request payment.”
Q. I have a claim with a date of injury of 6/14/19 where an employee was drinking a soda and suddenly felt chest pain. As he leaned forward to alleviate the pain and pressure, he fainted, which caused a fall resulting in head and back lacerations/abrasions. He was treated for the chest pain as well as the lacerations from the fall. The employer was aware of the injury on the date it occurred and took him to the ER for treatment. The claim was never reported as a workers’ compensation claim—as the employer did not believe it to be work-related. The carrier only received notice of the claim on 6/17/20 upon receipt of a bill from the ER for treatment on 6/14/19. Since the employee failed to file a claim with the Division within one year of the injury, is there a sufficient basis to deny the claim in its entirety based on Sec. 409.003?
A. No, if the employer fails to deliver to the carrier a written report of the injury or the carrier fails to file the report of the injury on behalf of the employer according to TLC Section 409.005, the one-year period for filing the claim for compensation under TLC Sections 409.003 and 409.007 is tolled, and the one-year filing period does not begin until the day the injuries are reported as required by TLC Section 409.005. TLC Section 409.008; APD 980792.
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