Frequently Asked Questions -- Health Care Disputes
Since 1985, if there were not other issues in dispute, the Wisconsin Department of Workforce Development resolved disputes between providers and insurers regarding the cost of health care provided to injured workers. Through out the years, the department has received numerous questions. These represent ones asked most frequently.
Who should I send a bill for worker's compensation bill to?
The best way for you to receive timely payment is to identify the worker's compensation carrier or third party administrator for the employer of the patient. Do this as soon as the patient calls for an appointment.
How can I find the insurer and contact person to send the bill to?
Contact the employer as soon as possible after the patient contacts you for treatment. Tell the employer who you are treating or planning to treat and find out who the responsible person is at the insurance carrier or third party administrator.
What if the employer refuses to give me the name of the insurer?
You can look up the insurer from the name and location of the employer by using the insurance carrier lookup on our website, or by calling this division at 608/266-1340 and asking for the Bureau of Insurance. Otherwise you can send an e-mail to request a look up for an employer by clicking the contact link below; be sure to give the full name of the employer and their city and zip code (if known). Ask for Insurer Look-up
Can I bill an employee for unpaid medical bills?
Once you send a bill to the proper worker's compensation insurer you are barred from billing the worker until liability is determined (under Ind. 80.73). If it is determined that there was no compensable injury under worker's compensation, you may seek recovery of unpaid bills from a health insurer or the patient.
I sent a bill some time ago and have not heard from the insurer. What can I do to get paid?
If the Insurer has not contacted you in sixty days after you mailed your proper bill for services to them, you may write the Division and ask for a default judgment for the unpaid bill. Please be sure to attach a copy of your bill and any proof that you mailed the letter to the insurer, such as a postal certificate of mailing, affidavit of mailing by your staff, or other proof of mailing. Necessity of Treatment
What happens if the worker's compensation carrier denies the claims as being not work related and the health insurer is then billed and denies coverage because the injury was work related?
Have the patient fill out an application for hearing. An Administrative Law Judge can decide whether or not the claim was occupational. Some insurers may be willing to compromise the claim without the necessity of a formal hearing. Be prepared, however, for a nine month or longer wait for a final judgment through the hearing process.
The insurer will not tell me why they reduced my charges. What can I do to find out why?
Ind. 80.72(9) requires that the payer tell you why they reduced your charges. If they based it on a certified database, they must tell you the name of the database provider. Click here to see a list of certified databases for Wisconsin. Reasonableness of Fee
I got a letter from the Division ordering the payer to pay my fee and they have not paid.
We ask that you contact the payer and seek prompt payment of the amount ordered for payment. If the payer does not pay, write us and ask for a certified copy of the order - the Certified copy can be entered as a judgment in circuit court.