Keeping Health Care Matters Private and Getting Bills Paid

June 22, 20200

Injured railroad workers all have medical bills, and the seriously injured workers have ongoing care that can take months or even years to resolve. One would think that the process of going to the doctor in private and having medical bills paid in a prompt and efficient manner would be simple and a painless process. Unfortunately, our clients report constant problems with the railroad being too involved in their care and not paying for medical bills, even if the claim agent asked the injured worker to see a particular doctor or have a specific test.

The railroad claim agent typically tells the worker that he has the power to review the records and approve any medical treatment for on-the-job injuries, but there is more to the story. In fact, the claim agent has the power to review the treatment records if the employee allows the claim agent to pay the co-pay; however, if the employee will write a Letter of Authorization to the health care company informing them that the worker will pay all future co-pays, he has the ability to keep the claim agent completely out of the care. The worker simply needs to tell the doctor or medical provider that there has been a change and that all bills associated with their injury should be paid from their contract health coverage. The worker tells the medical provider that, going forward, no one other than the health care provider and the patient/injured worker should be involved in the care, and then the care is completely out of the railroad’s hands, and the claim agent has no more say in what care is provided.

In the past three years, we have noticed a change in how the railroad handles these situations. The railroads contract with a third party – one we see frequently is Corvelle – and a “nurse” will simply show up to a doctor visit uninvited and tell the doctor all treatment must be approved by them. In some cases the injured worker does not even know that a Corvelle nurse is assigned to his case, but he cannot figure out why his treatment is not scheduled or approved. The answer is that the “nurse,” whom he has never met, has not approved the treatment or test and is dragging their feet. In other cases, a bill for treatment does not get paid because the “nurse” has not approved payment, and the bill is turned over to collections to collect from the employee (which could affect your credit) because the nurse assigned to help the worker will not do her job. A Letter of Authorization as described above will remove the “nurse” from the care, will get the bills paid promptly, and will make the health care a private matter between doctor and patient.

Injured railroad workers covered under the Railroad Employees National Health and Welfare Plan (commonly known as GA 23000) have excellent health care coverage, and we have found that by knowing how the system works, they can get their bills paid and keep the railroad and its agents completely out of the private matter of personal health care. At our firm, we try to help our clients and union members with just these types of issues. Paul Wingo is the Director, Disability Claims and Benefits at Steel & Moss and is available to help with these and any disability or insurance question you have. Paul’s cell number is (423) 802-7351.

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