If the OWCP accepts a claim, the claimant may be entitled to medical benefits, wage loss compensation and a schedule award. Like insurance companies, the OWCP does not usually pay the medical provider’s bill in full. So what happens to the balance: that is the difference between the amount billed and the amount paid by the OWCP? The practice of medical providers looking to the claimant to pay the difference between the amount paid and the amount billed is called balance billing, and this practice is not allowed under federal law. If a provider’s bill is reduced by the OWCP in accordance with its fee schedule or other tests of reasonableness, the provider is not allowed to charge the claimant for the remainder of the bill. So, if an authorized service has been billed to the OWCP, the claimant is not responsible for charges over the maximum allowed in the OWCP fee schedule.
20 C.F.R. §10.801 (d) provides that by submitting a bill and/or accepting payment, the provider signifies that the service for which reimbursement is sought was performed as described and was necessary. In addition, the provider thereby agrees to comply with all regulations concerning the rendering of treatment and/or the process for seeking reimbursement for medical services, including the fee schedule’s limitation imposed on the amount to be paid for such services. See also 20 CFR §10.813. In sum, a claimant is not required to pay the medical care provider the difference between what was billed and what the OWCP paid.
If you need legal counsel to discuss your rights under the Federal Employees’ Compensation Act (FECA) you should contact OWCP Attorney Gregory A. Hall to schedule a consultation.