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Houston, TX (WorkersCompensation.com) – An increase in complaints from injured employees billed for services they received has led Texas workers’ compensation officials to draft new legislation to help them.
According to Texas Lawyer, the Texas Department of Insurance Division of Workers’ Compensation found that it was receiving an increased number of complaints from injured employees who had been treated at Brooke Army Medical Center in San Antonio. In some cases, the injured workers were charged thousands of dollars for services they received as part of a workers’ compensation claim.
“When our data showed that injured employees were being billed thousands of dollars for services they received, a red flag went up,” Cassie Brown, Workers’ Compensation Commissioner said. “The basic premise of workers’ compensation insurance coverage in Texas is that injured employees receive benefits at no cost for compensable injuries and, in return, employers are protected from most lawsuits.”
Officials said state and federal guidelines regarding workers’ compensation claims conflicted and some workers’ compensation insurance carriers only applied state guidelines to cases in order to deny claims, or to only pay a portion of the charges.
On the provider side of the equation, however, federal law required that military facilities collect on all billed charges. Because of that any remaining balance from the claim was sent to the injured workers. And if the injured worker failed to pay the debt within 90 days, the debt was turned over for collection to the US Treasury Department. In many cases, the injured employee’s income was garnished, including tax returns and Social Security benefits, the DWC said.
In response, DWC officials drafted Senate Bill 935 which would require workers’ compensation insurance companies to reimburse federal treatment facilities for medical care at the same rate provided by federal regulations. The bill would also require that medical care provided at federal facilities is exempt from state workers’ compensation rules requiring pre-authorization and billing.
According to the draft legislation, the bill requires insurance carriers to:
- Process professional and institutional medical services submitted by an federal medical treatment facility on a single bill
- Identify reimbursement for professional and institutional services separately on the explanation of benefits form
- Forward to the division, within 14 calendar days of receipt, the first medical bill for an injured employee that it receives from an FMTF
- Report medical bills to the DWC
Insurance carriers could only deny payment for reasons of medical necessity, compensability, extent or liability, the legislation said.
A comment period for the bill extends until July 15, 2019.
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About The Author
About The Author
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Liz Carey
Liz Carey has worked as a writer, reporter and editor for nearly 25 years. First, as an investigative reporter for Gannett and later as the Vice President of a local Chamber of Commerce, Carey has covered everything from local government to the statehouse to the aerospace industry. Her work as a reporter, as well as her work in the community, have led her to become an advocate for the working poor, as well as the small business owner.
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