Today’s question is worth being a blog post because it’s one I get quite often. I suspect employers try to file medical bills from work injuries with the health insurance thinking it will save them premium dollars on the workers’ compensation policy. Wrong! Wrong! Wrong! Stop already, just follow the rules and knock-off trying to game the system. It never works out as you think it will. Insurance company lawyers and CEO's who designed these systems aren't stupid. Health insurance and workers' compensation insurance programs are mutually exclusive and have time sensitive filing requirements. By trying to game the system you can lose the right to get reiumbursed for the bill. So, let us see how to answer this potential client's question.
Question: Can the employer bill my personal insurance for an x-ray to diagnose a work comp injury?
Question Detail: I was sent back to work with a back injury before performing an MRI or sending me to a specialist. My back was reinjured two months after returning. They denied the MRI claim, and then supposedly took care of it, and now one month after it was "taken care of" I received another bill turning me over to collections. As a nurse, I know to research issues and I don't think this is how it supposed to be handled. [Yeah you’re right about that.] I have documented all my phone calls and email from my employer regarding the issues. I really need some sound legal guidance.
Answer: The quick answer is he can do it if he lies, but shouldn’t do it and you shouldn’t let him do it. If he does you’ll be paying the co-insurance and maybe a deductible under the health insurance policy, but more importantly you'll risk losing the right to pursue a workers' compensation claim and get the bill paid by any insurance. Under workers' compensation you won’t have a co-insurance or deductible. There is never a deductible or co-insurance payment for medical care provided by workers’ compensation insurance. If the injury is sustained at work then it's generally covered under Iowa's workers' compensation with no deductible and no co-insurance payments by the employee. [Have I said that enough times?]
Although I said he can, I did not mean to imply he should. It’s not proper under the terms of most health insurance programs and when the health insurance company finds out they will back out of paying and may even demand to be reimbursed. Hopefully by then it won’t be too late to file under workers’ compensation.
When the workers’ compensation carrier finds out the bill was first submitted to the health insurance, they will then balk at paying for it under workers’ compensation insurance for more reasons than I care to discuss. This is a dumb idea that causes an enormous paper chase, with denials coming from every direction. Then of course the employer goes public and blames it all on “the lawyers”; which we know is complete BS.
Take the bill to your employer and politely but firmly ask them to resubmit it to workers’ compensation insurance. If they won't, then ask for the name of the insurance company providing workers' compensation coverage and send it to them. If they won’t give you the name of the insurance company then you’re options are to walk it over to a lawyer’s office who will then open a claim if that is what is required.
Good luck and if we can help give us a call.