| Author | Subject: Re: reimbursements for travel,etc. |
| Resource | Posted At 22:25:42 02/07/2001
I suspect they are disallowing your out of pocket expenses because there are similar specialists available in your geographic area. The rule on this is as follows: 656.245 (e)Except for services provided under a managed care contract,out-of-pocket expense reimbursement to receive care from the attending physician shall not exceed the amount required to seek care from an appropriate attending physician of the same specialty who is in a medical community geographically closer to the worker's home. For the purposes of this paragraph, all physicians within a metropolitan area are considered to be part of the same medical community. Also - look at 436-060-0070 - Reimbursement of Related Services Costs -There are time frames which must be followed and rules about what the insurer must tell you about why you aren't being paid. Look carefully at the letter to make sure they are advising you why these are disallowed. If no reason is listed or the information is supplied to you over 30 days after you asked for the reimbursement, you should appeal their decision not to pay or ask for penalties for the delay. The current rate is 32.5 cents per mile effective 4-1-2000. See Bulletin 112 for all the details on the current reimbursement rates. http://www.cbs.state.or.us/external/wcd/bulletins/bul_112.pdf Hope this helps |
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