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Balance Billing

The practice of providers billing employees and employers for unpaid balances is prohibited.

Excerpts from Memo from Workers Compensation Board of Indiana dated January 1, 1995:
"The practice of billing employees and employers for unpaid balances incurred under the Act is prohibited by the provisions of IC 22-3-3-4 and IC 22-3-3-5. IC 22-3-3-5.1 provides that the board shall, upon hearing, assess civil penalties of between $100 and $1000 for medical providers who knowingly collect or attempt to collect fees from employees covered by the Act. However, a medical provider who bills an employee in good faith, or without knowledge that a medical bill was incurred under Act, shall not be fined.

The board encourages agreements ( i.e. preferred provider arrangements) between employers, carriers, and medical providers concerning the level of payment for medical services. In the absence of a statutory provision, any such contractual payment agreements will take precedence over the Board's criteria.

The Worker's Compensation Board has begun ordering selected "balance billing" disputes to mediation. Selection of cases is at the discretion of the Board. The mediation rules adopted by the Indiana Supreme Court apply. Parties may avoid mediation by submitting a final resolution of all issues by written agreement."

In general, if a provider is dissatisfied with the payment it received from the carrier, it can contact the bill review service and ask for an explanation and try to work it out the discrepancy. The provider can also contact the Board and the Board can advise on next steps, which could involve filing a claim.

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The material in this document has been prepared and shared for informational purposes only and should not be relied upon as legal advice on any particular situation.