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Oregon Workers Compensation Billing for Out of State Medical Providers
It is the “mundane” details that seem to most often drive injured workers crazy when they have an Oregon Workers’ Compensation Claim. One of the great worries is whether the medical bills will be paid.
Most medical providers when treating an injured worker will accept the amount paid by the Workers’ Compensation Insurer as payment in full. However, an injured worker with an Oregon Workers’ Compensation claim who is getting treatment from an out of state medical provider has to be aware of the possibility they will be responsible for the difference between the amount paid by the insurer and the amount charged by the medical provider. Mentioning this issue to the out of state medical provider before starting treatment can prevent the injured worker from getting the unpleasant surprise of personally owing amounts for their medical treatment.
When the worker is getting treatment for an “accepted condition” from an Oregon medical provider there are provisions in the Oregon statutes that limit the amounts a medical provider can charge. Once the Workers’ Compensation Insurer pays the statutory allowed amount, the medical provider must accept that payment as payment in full. This protects injured workers from being responsible for medical bills connected with their workers’ compensation injury.
The Oregon Workers’ Compensation Insurer only has to pay the amount set by Oregon law.
The problem some injured workers run into is when they get treatment for an Oregon Workers’ Compensation injury from an out of state medical provider. Because the Oregon laws do not apply to a medical provider who is not in the state of Oregon, the medical provider can charge any amount they choose. The Oregon Workers’ Compensation Insurer only has to pay the amount set by Oregon law. Often the amount set by Oregon law is less than the amount medical providers “normally” charge. This can leave the injured worker in the position of having to pay the difference between the amount paid by the Oregon Workers’ Compensation Insurer and the amount charged by the medical provider.
Getting treatment from an out of state medical provider.
Most medical providers when treating an injured worker will accept the amount paid by the Workers’ Compensation Insurer as payment in full. However, an injured worker with an Oregon Workers’ Compensation claim who is getting treatment from an out of state medical provider has to be aware of the possibility they will be responsible for the difference between the amount paid by the insurer and the amount charged by the medical provider. Mentioning this issue to the out of state medical provider before starting treatment can prevent the injured worker from getting the unpleasant surprise of personally owing amounts for their medical treatment.