Insurance Denied Payment for An Electric Muscle Stimulator
In Harburg Medical Sales Co. v. Bureau of Workers' Compensation (PMA Insurance Provider), 784 A.2d 866 (Pa. Cmwlth. 2001), a claimant was prescribed an electric muscle stimulator by a physician.
A medical sales company (a provider) furnished the equipment to the claimant and billed his insurer on January 9, 1998.
On March 4, 1998, the insurer denied payment stating that the service provided was not documented in the records received.
The provider responded by filing an application for fee review alleging that the insurer had not made payment in a timely fashion.
The Bureau determined that the insurer's payment was not late as the insurer was not required to pay the bill until the provider complied with the reporting requirements of Section 306(f.1)(2) of the Act.
The provider did not appeal the Bureau's determination.
Instead, it resubmitted its bill to the insurer on January 26, 2000.
The insurer again denied payment.
The provider then filed an application for fee review with the Bureau on March 11, 2000.
The Bureau determined that January 9, 1998, was the original billing date and March 4, 1998 was the date the provider was informed that the bill was disputed.
As an application for fee review had to be filed no more than thirty days following notification of a disputed treatment or ninety days following the original billing date of treatment, the Bureau determined that the application for fee review, filed on March 11, 2000, was untimely.
The provider then appealed to this Court.
The provider argued that as the insurer was not required to pay until the proper forms were filed, the statute of limitations could not begin to run until the bill was properly submitted and the provider was notified that the bill was in dispute.
Thus, the statue did not begin to run until it properly submitted its bill on January 26, 2000.
The Court agreed.
This Court determined that the Bureau had the authority to determine whether or not a provider has complied with the reporting requirements.
However, if the provider has not complied, it may resubmit the bill with the required reports.
"Any other interpretation would leave the provider without any recourse to seek payment for a disputed treatment if the provider is barred from resubmitting a bill that has gone through the fee review process and denied on the basis of failure to comply with the reporting requirements-a failure which can easily be remedied by providing the pertinent missing information or reports." Harburg, 784 A.2d at 870.