Balance Billing and Workers’ Compensation in Pennsylvania
Business Law Articles
By John W. Zatkos, Jr., Esquire
Rothman Gordon
Pittsburgh, Pennsylvania
What if I get a surprise health care bill while being treated for a work injury?
Balance Billing is when a provider charges a patient with the amount the insurance company doesn’t pay. Balance Billing is prohibited by the Pennsylvania Workers’ Compensation Act. Pennsylvania Code (34 PA Code § 127.21) says “A provider may not bill for, or otherwise attempt to recover from the employee, the difference between the provider’s charge and the amount paid by an insurer.” However, there are some instances where an injured worker may receive a balance billing invoice.