Source: https://www.chartwelllaw.com/resources/what-insurers-need-to-know-about-the-fee-review-process-in-pennsylvania
Timestamp: 2019-04-22 08:54:16+00:00

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Tips on controlling costs and limiting exposure.
7. You have to be practical. It does not make sense to litigate every bill in the fee review process. Even if an insurer does everything right, it will be far cheaper to pay a small bill than litigate it through to a decision. For that reason, there are times when negotiating with the provider is recommended. That is not always the case, however, and further analysis should be applied. For example, if the bill is small, does the provider bill that same treatment month after month? Or, do they provide that treatment to multiple patients? In addition, are there legitimate questions about whether the care qualifies as medical treatment, or whether the provider is actually recognized as such under the Pennsylvania Workers’ Compensation Act? These are all good questions to keep in mind, because there are times when fighting a small dispute can have a huge effect on an insurer’s bottom line.
At first blush, the fee review process can be complex and confusing. Don’t worry, you are not alone. The truth is most workers’ compensation attorneys don’t fully understand this area of law, and even fewer regularly practice it. With the help of an expert in the field, however, you can develop a thorough and rigorous approach to each stage of the fee review process, thus forming an effective tool in reducing costs and limiting exposure.
A graduate of the University Of Notre Dame, Jonathan P. Spadea is an Associate with the Chartwell Law Offices in Camp Hill, Pennsylvania. He has helped some of the largest insurers in Pennsylvania navigate the fee review process, including appeals to the Commonwealth Court. If you have any questions about the above, or require additional assistance with your own fee dispute, he can be reached at jspadea@chartwelllaw.com or (717) 686-9582.
‍1 134 Pa.Code. § 127.251.
2 Crozer Chester Med. Ctr. v. Dep’t of Labor & Indus., 610 Pa. 459, 22 A.3d 189 (Pa. 2011).
3 34 Pa.Code. § 127.259(f).
4 34 Pa.Code. § 127.259(a).
5 Thomas Jefferson University Hosptial v. Bureau of Workers’ Compensation Medical Fee Review Hearing Office, 794 A.2d 933, at 934 (Pa.Cmwlth. 2002).
6 34 Pa.Code. § 127.252(a).
7 34 Pa.Code. § 127.257(b).
8 34 Pa.Code. § 127.101, et. seq.
9 34 Pa.Code. § 127.207.
10 34 Pa.Code. § 127.254; see also, Philadelphia v. Medical Fee Review Hearing Office, 737 A.2d 356 (Pa.Cmwlth. 1999).
11 34 Pa.Code. § 127.128.
12 See, Geisinger Health System v. Bureau of Workers’ Compensation Fee Review Hearing Office (State Workers’ Insurance Fund), 138 A.3d 133 (Pa.Cmwlth. 2016); and, Allegheny General Hosp. v. Bureau of Workers’ Compensation Fee Review Hearing Office (State Workers’ Insurance Fund), 143 A.3d 449 (Pa.Cmwlth. 2016).

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