No Balance Billing under Virginia Workers Compensation

Those of you who have sustained an injury by accident at work for which you received a lifetime medical award from the Virginia Workers’ Compensation Commission know that you typically do not have to worry about receiving a bill for treatment with your physician and other authorized health care providers. These bills are covered by your workers’ compensation insurance carrier and should be sent directly to the carrier. The only item you may have to worry about is obtaining reimbursement for co-pays made at those visits.

There are, however, times when you may receive a bill directly from the health care provider for the “balance due” after payment was made by the workers’ compensation insurance carrier. A balance due may result if the workers’ compensation insurance carrier declined to pay all of the health care provider’s fee or charge because it was above the contractual rate or prevailing community standard. Sending an invoice for the unpaid balance directly to the injured worker is a practice known as “balance billing.”

Balance billing is not allowed under Section 65.2-714 of the Virginia Workers’ Compensation Act. A health care provider may not seek payment of the balance due after partial payment by the workers’ compensation insurance carrier from the injured worker. If you are threatened with such an invoice, then contact an attorney or the Commission to determine your rights.

Corey Pollard is a workers’ compensation attorney and disability lawyer with Jenkins, Block & Associates in Richmond, VA. Contact him today for a free initial consultation. He represents injured and disabled workers throughout Virginia.