What To Do When A Bill For Treatment Isn’t Paid

Health Provider’s Request for Decision on Unpaid Medical Bill(s)

When a payment to a medical or health care provider has been unsuccessful for services rendered to a patient with a Workers’ Compensation case, the Health Provider’s Request for Decision on Unpaid Medical Bill(s) (HP-1 Form) will need to be submitted. It should be noted that a minimum of 45 days must pass after submission of the medical bill(s) to the carrier before the HP-1 Form can be submitted. New York State’s Workers’ Compensation Board recommends waiting a period of 60 days because many carriers make their payment(s) during that time frame.

Process of Disputing Medical Bills

There are two choices offered to those with a workers’ comp. case submitting the HP-1 Form to assist with the disputed bill(s) process. The choice that you make will be dependent upon the carrier’s response (or lack of) to your submitted bill(s).

  1. Administrative Award: This is the option that should be used when the insurance carrier has not responded to your bills within 45 days with a written objection. The HP-1 request being submitted has to be received by the Board’s Disputed Medical Bill Unit (DMB) within 165 days after the bill was submitted to the carrier. The health provider must sign the HP-1 and a copy of the bill that was originally submitted to the insurance carrier. An Administrative Award is generated based on the established WCB medical fee schedule. The carrier will then have an opportunity to respond to this award. The Board will take the response into consideration in addition to the evidence provided and then will either rescind or uphold the award.
  2. Arbitration: The arbitration option is used when the insurance carrier has responded to the bills with a timely, written, objection (45 days). The HP-1 Form must be submitted to the DMB within 120 days from the time you received the carrier’s objection. However, there are two forms of arbitration – desk arbitration and panel arbitration.
    1. Desk arbitration: This involves a single arbitrator reviewing the submissions and issuing a decision without a hearing.
    2. Panel arbitration: A hearing is conducted with an arbitration panel. The parties involved may appear and present their arguments.

A dispute that involves less than $1,000 are resolved by desk arbitration; providers seeking arbitration in a dispute that is greater than $1,000 may elect either desk arbitration or panel arbitration. The attorneys of Erwin, McCane & Daly urge you to maintain an up-to-date and accurate record of your medical bills and if there are any left unpaid so that you may submit the HP-1 Form within the specific time limits.