Workers' Compensation: The Application for Fee Review Process

A Workers' Compensation (WC) insurance carrier has 30 days to pay your bill, deny the worker's claim for benefits, or request a utilization review. If your payment is late or incorrect, file for fee review. Incorrect payment would include any "network discounts" the insurance carrier asserts.

Only coordinated care organizations (CCOs) are allowed to apply a discount to the state's WC fee schedule, and there are no registered CCOs in Pennsylvania. Therefore, if an insurer attempts to discount your bill, file for fee review.

Also, it’s not uncommon for insurance carriers to lag behind in annually updating their fee schedules. Make sure you’re receiving your 3.6 percent increase for all services provided as of Jan. 1, 2008.

Publication: Workers' Compensation: The Application for Fee Review Process

This publication from the Pennsylvania Medical Society provides answers to why, when and how to file for a fee review by the Bureau of Workers' Compensation and includes sample proof of service and physician lien forms. State Society members can order a printed copy of Workers' Compensation: The Application for Fee Review Process through our online store or can download the PDF below.


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Comments: 2


I have been fighting with coventry, aetna, devon, focus, about the ppo discount in reference to workman's compensation. You need to be presistent If enough providers complain, something will be done. Unfortunately, most providers just accept the discount. It cost more to fight it. Just my opinion

anonymous at 7/12/2011 12:27:25 PM


I've seen the amounts that the U.R.O. fee's charge. Its' just mind boggling on what the Insurance and doctors are willing to pay. Even when they know there are wrong there are still willing to pay. I believe it will be a lot cheaper to settle. We are running for the best interest for us all not a Government Committee

ansanti152 at 6/17/2011 1:00:55 PM

Last Updated: 5/19/2008
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