Last Updated: 4/6/2023
Iowa is an employer choice state which generally means that the employer and/or their insurance company get to choose the medical providers that their injured workers go to. With this in mind, they are also supposed to pay for the medical bills for the medical providers they choose. So the biggest issue for medical providers is to make sure they are an authorized medical provider. If they are not authorized, then chances are very high that the workers' compensation insurance company will not pay their bill and they will have to look for payment elsewhere. This can mean submitting the bills to the patient's health insurance company and/or payment directly from the patient.
Another issue that comes up is if the workers' compensation claim has been denied. If the claim has been denied, then the injured worker should have received a letter stating it. The medical provider can ask for a copy of the letter for their records should they need it. If the injured worker's claim has been denied then Iowa law provides that the patient's health insurance company shall pay for the medical care and treatment. Iowa Code § 85.38(2)(a) provides:
If an employer denies liability under this chapter . . . for payment for any medical services received by an employee with a disability, and the employee is a beneficiary under either an individual or group plan for non-occupational illness, injury, or disability, the non-occupational plan SHALL NOT deny payment for the medical services on the basis that the employer's liability for the medical services under this chapter . . . is unresolved.
First of all, the medical provider should have in writing that their medical care and treatment is being authorized and approved by the work comp. insurance company. However, even for authorized medical providers, many insurance companies will "audit" the bill and reduce the amount of payment that the medical providers receive. Sometimes medical providers will then bill the injured worker for the difference of what they charged minus what they were paid which is not allowed under Iowa law. If there is a dispute about the reasonable charge for the medical care entered, the medical provider and the insurance company can take their dispute before the Iowa Workers' Compensation agency. This should not be a dispute that the injured worker is involved in.
Overall, billing a workers' compensation insurance company can be sometimes frustrating and difficult. However, if the above suggestions are followed it should make things less difficult.
If you are an Injured Worker and need more info or help you can contact us here or call us at (641) 792-3595.
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