Put it in Practice March 2022: Monthly Tips for Florida WC Professionals

AVOIDING PFB MEDICAL BILL LANDMINES

How you respond to PFBs that include medical bills is critical;  the wrong way can expose carriers and employers to unnecessary fees.  Fortunately, there is an easy way to avoid attorney fees for bills that are paid later than the 45 days typically extended to carriers.

• If you receive a PFB with bills for a provider and dates of service that were authorized, you should simply respond, “The employer/carrier agrees to the financial responsibility for the bills (list the bills and dates of service).” 

• (This response is only appropriate if you know the provider and date of service is a bill the carrier is responsible for.)

• Under current case law, by making this simple statement, you won’t owe any fees no matter WHEN the bill is paid.  Further, the JCC won’t even have jurisdiction to hear the issue.  

NOT SURE IF YOU ARE RESPONSIBLE?

• If there is any question, work to determine responsibility within 30 days of receipt of the PFB.  

• Only if you cannot determine responsibility within 30 days should you respond with the language of “will pay upon proper submission, per fee schedule if causally related.”

• A PFB should contain a specific listing of all medical charges alleged unpaid, including the name and address of the medical provider, the amounts due, and the specific dates of treatment.  If it does not, have your lawyer file a Motion to Dismiss the PFB, as it doesn’t meet the specificity requirements of 440.192. 

If you have any questions, please feel free to call us.

This month’s author is Tony Amelio.  AAmelio@hrlawflorida.com