Section 127.211. Balance billing prohibited

(a) A provider may not hold an employe liable for costs related to care or services rendered in connection with a compensable injury under the act. A provider may not bill for, or otherwise attempt to recover from the employe, the difference between the provider’s charge and the amount paid by an insurer.

(b) A provider may not bill for, or otherwise attempt to recover from the employe, charges for treatment or services determined to be unreasonable or unnecessary in accordance with the act or Subchapter C (relating to medical treatment review).

Notation

Notes of Decisions

A medical provider is prohibited from collecting from the employee claimant the difference between the amount paid by the employer or Workers’ Compensation carrier and the provider’s charge. Nickel v. Workers’ Compensation Appeal Board (Agway Agronomy), 959 A.2d 498, 504 (Pa. Cmwlth. 2008).

A claimant is never liable for the difference between that charged by the health care provider and that paid by the employer. Jaquay v. Workers’ Compensation Appeal Board, 717 A.2d 1075, 1078 (Pa. Cmwlth. 1998).