08/10/2021

Billing Patient for Statutorily Excluded Services-WC and Private Insurance

In a case where a person has Workers' Compensation and a private major medical policy, can the latter be billed for services that are statutorily excluded by Workers' Comp (such as physical therapy administered by a podiatrist)?

If a patient receives a service for a condition that is not related to their worker’s compensation injury, the service should be billed to their major medical insurance as primary. In most cases, if a patient receives a routine service like nail care or has an x-ray for a condition that is not related to their injury, this should be billed to the medical insurance. Infrequently, the insurance may require a denial from the WC carrier before covering the service, but this is rare for services that are not related to the patient’s reported injury. The exact same conditions would apply with no-fault cases for medical care that is not related to the MVA.