The recent passage of HB3452 which took effect November 27, 2018 now enables medical providers to be awarded a 1% per month interest penalty on bills paid later than 30 days and grants them the opportunity to bring civil action directly against employers or their representatives. Under the updated law, payment must be made within 30 days of a medical bill being presented to an employer or its representative, or an explanation of benefits form – stating the reason for the partial or full denial of the medical charges, for example, missing data elements – must be provided.
This new development in the law has several important ramifications for our clients:
-Employers could be exposed to penalties if employees receiving medical bills directly do not immediately present them to the appropriate person.
-Employers must present medical bills to TPAs/insurers via email and provide details on when they received bills, so that TPAs/insurers can dispute or pay within 30 days.
-Workers’ compensation insurers may not cover defense costs in civil actions filed by providers if payment delays are related to employers’ actions.
Points To Remember!
-A claim for payment of medical bills must still contain the required data elements necessary to adjudicate the bill.
-Employers still have the right to deny payment of a bill if that required data is missing OR if the bill is being denied for a legitimate reason such as denial of work accident, failure to pass utilization review programs, etc. HOWEVER such a denial must be provided in writing setting forth the basis for the denial of the bill within 30 days of receipt of the bill.
-Failure to provide written basis for denial and failure to pay the bill within 30 days, may result in a 1% interest per month which is due within 30 days of the payment of the bill. In addition, failure to provide a basis for denial or pay the bill, may also give rise to civil action by the provider. This also means that medical providers do not have to rely on the Petitioner’s attorney to seek payment of interest at trial.
1301 W 22nd St
Oakbrook, IL 60523
222 W. 6th Street
San Pedro, CA 90731
Copyright ASA Law Group 2021. All rights reserved.