The Official Partner of the American WorkerSM
All calls are confidential and there are no fees until we win.
Free Case Review Call Us (267) 651-7945
Close
No Recovery No Fee Guaranteed
The Official Partner of the American WorkerSM

How Do Medical Bills Get Paid on Workers’ Comp in Pennsylvania?

I represent injured workers in Pennsylvania. In addition, I represent doctors and other medical providers, in getting their medical bills paid by the work comp insurers.

The Pennsylvania Workers’ Compensation Act has specific requirements that must be met in order for work-related medical treatment to be paid by an insurer. The following will explain these technical requirements and will also address Fee Review procedures.

Deadlines

It is very important that all treatment gets billed on the proper forms, within 30 days, and with the corresponding medical reports. Any failure to meet the billing requirements under the Work Comp Act will be used as a way for the insurer to wiggle out of payment.

Forms

Please be advised that any medical bills for work-related treatment must be made on either a HCFA form 1500 or the UB92 (HCFA form 1450), or any successor forms, required by HCFA for submission of Medicare claims. Until a medical provider submits bills on one of these forms, insurers are not required to pay for the treatment billed.

Further, providers who treat injured employees are required to submit periodic medical reports to the employer, commencing 10 days after treatment begins and at least one month thereafter as long as treatment continues. If the employer is covered by an insurer, the provider shall submit the report to the insurer.

The medical reports referenced above shall be submitted on a form prescribed by the Bureau for that purpose. The report shall include the history, a description of the treatment and services rendered, the physical findings and the prognosis, including whether or not the claimant can return to pre-injury work without limitations. Reports are not required to be submitted for months in which no medical treatment has been rendered. Once again, if a provider does not submit the required medical reports on the prescribed form, the insurer is not obligated to make payment.

Payments

Payments for treatment must be made within 30 days of receipt of the bill and report submitted by the provider. Insurers shall supply a written explanation of benefits (EOB) to the provider, describing the calculation of payment of medical bills submitted by the provider. If an insurer fails to pay the entire bill within 30 days of receipt of the required bills and medical reports, interest shall accrue on the due and unpaid amounts at 10% per annum.

Balance Billing- Prohibited

A provider may not hold an employee liable for costs related to care or services rendered in connection with a compensable injury under the Act. A provider may not bill for, or otherwise attempt to recover from the employee, the difference between the provider’s charge for treatment and the amount paid by an insurer. This holds true for treatment determined to be unreasonable or unnecessary.

Disputes

A provider who has submitted the required bills and reports to an insurer and who disputes the amount or timeliness of the payment made by an insurer, shall have standing to seek review of the fee (Fee Review) by the Bureau. Providers seeking review shall file the original and one copy of a form prescribed by the Bureau as an application for Fee Review, and shall be filed no more than 30 days following notification of a disputed treatment or 90 days following the original billing date of the treatment- whichever is later. A copy of the application and the attached documents, shall be served upon the insurer, with a proof of service. For more information on Fee Review, see the cost containment regs at Sections 127.251 and continuing.

Fee Review

A provider who has submitted the required bills and reports to an insurer and who disputes the amount or timeliness of the payment made by an insurer, shall have standing to seek review of the fee dispute by the Bureau. Providers must apply for fee review within 30 days following notification of a disputed treatment or 90 days following the original billing date of the treatment which is the subject of the fee dispute, whichever is later. For more information, please see Section 127.252, et seq of the Medical Cost Containment Regulations under the Act.

In summary, you must use the proper HCFA form and submit this with the bill and a legible, detailed medical report, for each month in which treatment is rendered, if you want to get paid.

 

Pennsylvania Workers’ Comp Attorney

Awards & Recognitions

Philadelphia workers comp lawyer
Philadelphia workmans comp lawyer
Bucks County workers comp lawyer
best workmans comp lawyer philadelphia
Philadelphia Workmans Comp Lawyer
Top 10 Attorneys Award Pennsylvania workers' comp lawyer
Philadelphia workmans comp lawyer
Philadelphia workers compensation lawyer
best bucks county workmans comp lawyer
Avvo Rating 10.0 Philadelphia workers' comp lawyer
Workmans comp lawyer
best workmans comp attorney
best Philly workmans comp lawyer
Bucks county workmans comp lawyer
best Philadelphia workmans comp lawyer

Cardamone Law Has Negotiated Some of the Largest Workers’ Comp Settlements in Pennsylvania

$6 Million
We Assisted Another Firm in Reaching Settlement
$2.2 Million
Spinal Injury
$897,000
Lower Back Injury
$650,000
Lower Back Injury
$550,000
Neck Injury
$425,000
Leg Injury
$375,000
Knee Injury
$325,000
Ankle Injury
$6 Million
We Assisted Another Firm in Reaching Settlement
$2.2 Million
Spinal Injury
$897,000
Lower Back Injury
$650,000
Lower Back Injury
$550,000
Neck Injury
$425,000
Leg Injury
$375,000
Knee Injury
$325,000
Ankle Injury

Client Testimonials

"Thank you from the bottom of my heart Mike and Shirley!!"

I called Shirley when I was scared and didn’t know what where my next dime was coming from after I was out with my work injury. Shirley was very kind and helpful guiding me every single step of the way. Mike was not your typical lawyer was not pushy but very responsive to all my gazillion questions. He helped me get my settlement quickly and settlement check in a very timely manner. Would recommend them to anyone! Mike helped calm all my fears and anxieties as I was trying to navigate one of the hardest and most stressful times in my life. Thank you from the bottom of my heart Mike and Shirley!!

- Jen Thompson
Google Reviews
"Tienes un equipo impresionante a pesar de ser una compañía pequeña, los resultados fueron excelentes!"

Yo le daría 10 estrellas en vez de 5 , Michael Cardamone es una persona genuina y un gran abogado, al principio de mi caso, yo estaba en la oscuridad y no sabia que pasos tendría que seguir porque Workers comp ,solo me cubría en esos momentos los beneficios medicos .Después, me eliminaron el puesto , no sabia como manejar mi situación (estaba con una cirugía y también sin trabajo,) grasias a Mike, el me dirigió por el camino correcto, me dieron una muy buena cantidad por mi caso. El fue muy comprensivo porque le hice muchas preguntas por email y siempre me las contesto a tiempo, brindando seguridad ,sabia que estaba en las manos correctas! Shirley y Francisco también fueron de gran ayuda con los recordatorios y servicios de traducción en Español. tienes un equipo impresionante a pesar de ser una compañía pequeña, los resultados fueron excelentes! se los recomiendo a todos. Muchas grasias Cardamone law!

- Marisol Rodriguez
Google Reviews
"Best Law Firm around!"

"Cardomone law is absolutely fantastic! They are very responsive and helpful and they will fight to get you what you deserve. Shirley is also very helpful whenever you have any questions! Best Law Firm around!"

- C. Edwards
Google Reviews
"Michael and Shirley are very dedicated...and getting the maximum amount favorable to my case"

"Cardamone Law Firm were very helpful to me since day one. Michael and Shirley are very dedicated to my case giving me updates, answering my questions, being honest with my case, and getting the maximum amount favorable to my case. Thank you so much for your service and dedication and helping me to achieve not only your case but to guide and refer me in other needs too! You guys are the best law firm friendly and dedicated. I will recommend to anyone."

- A. Ortiz
Google Reviews
"Michael won my workers comp case after my employer insurance denied my claim."

"Exceptional firm. Highly recommend this law firm. Michael won my Workers Comp case after my employer insurance denied my claim. Him and his staff were always at my reach for legal and emotional support. Am so happy I hire them. Thanks Michael and Ms. Shirley."

- Carlos P.
Google Reviews
"[They] did an excellent job in getting me financially compensated in a fairly short amount of time."

"I recently had a work related injury and was receiving Workers' Compensation (medical benefits only). Soon after I was fired, so I contacted Paul Silver at Cardamone Law Firm who did an excellent job in getting me financially compensated in a fairly short amount of time. Paul and his assistant Shirley always responded to any questions I had about the case in a very short amount of time. Thank you for helping me with this difficult case."

- Robin C.
Google Reviews
"Highly recommend."

"Cardamone Law was great with helping my husband with his Workers Comp issues. Mike and Shirley were the best with letting us know what was going on every step of the way. Highly recommend."

- Danielle P.
Google Reviews
"Mike Cardamone is amazing"

"Mike Cardamone is amazing. He is "hands down" one of the best lawyers I've ever had the privilege of knowing. He is very kind, understanding, knowledgeable in his field, always very thorough and helpful. He was extremely professional and someone who truly cares about his clients. I felt completely at ease with him. He was a pleasure to work with, explained everything in detail, as well as answered all my questions with knowledge and care. If you want someone you can trust, who communicates every step of the way, will fight for you and make sure you win your case, he is it! I will refer all my family and friends to him. Thank you so much Mike, for everything. I appreciate all your hard work and dedication in helping me."

- Allie M.
Google Reviews
Without a doubt YOU are the best!!!

"Without a doubt YOU are the best!!! Every person who is in the horrible position of being injured at work should have someone as kind, compassionate and knowledgeable as you on their side. You never once made me feel like I was one of a hundred other clients. I always knew you had my back! You answered calls and emails at all hours. You fought every fight for me so I only had to worry about getting well. Behind your nice, calm face there’s a pit bull ready to take on any employer or judge. I can never thank you enough."

- L. Edall
Google Reviews
"Best Workers' Comp Lawyer!"

"Michael is simply the best! He was there for me from day 1 till the end, and we won the case!! He is always available to help. I had a gazillion questions and he would answer them one by one. He's a great lawyer and I feel lucky to have found him online from reading other outstanding reviews about him. Believe me, they're true!"

- Faith B.
Google Reviews
"Great Attorney"

"Great attorney, handled case quickly and efficiently. I would recommend him and would use him again. He was always available to answer any questions we had. Thank you, Mr. Cardamone."

- H. Anderson
Google Reviews