Can I Get My Co-Pays for the Doctor Back?

Are you paying out of your pocket for your compensation treatment case | Syracuse, NY Workers' Compensation Lawyers | MCV Law

  • Can I get my co-pays for the doctor back?
  • Can I get reimbursed for mileage to and from the doctor?
  • Can I get reimbursed for my medications?

At Meggesto, Crossett & Valerino, LLP, we make sure our clients do not pay out-of-pocket for costs associated with their claims and that they receive the reimbursement they are entitled to.

Medical professionals, doctors, hospitals, and facilities treating you in New York State for your Workers’ Compensation injuries cannot bill or charge you for any costs. All billing is to be sent to the Insurance Company responsible for your claim. This is the law of New York State.

Sometimes, especially at the start of a claim, it may be unclear who your Workers’ Compensation insurance carrier is, or how they should be billed. If you happen to pay for any treatment, keep your receipt for reimbursement. Injured workers are not responsible for co-pays.

Likewise, if you are prescribed medications and the pharmacy is unable to bill the insurance carrier, you can be reimbursed for any costs you incur as a result. We encourage you to keep a receipt of such costs in order to be reimbursed.

In addition to the above reimbursements, you are also entitled to reimbursement transportation costs. This includes mileage reimbursement to and from your doctor visits. If you use a private vehicle to get to your appointments, the current reimbursement rate is $.56 per mile as of 1/1/2014. Below is a table of mileage rates for the past 5 years A complete listing of mileage rates is available and linked here

1-1-10 50
1-1-11 51
7-1-11 55.5
1-1-12 55.5
1-1-13 56.5
1-1-14 56

Mileage is paid round trip from the location you departed to attend the appointment to the point you returned to. Generally, this includes mileage from your home to the doctor or therapist and back home again. If you use public transportation or pay for parking or tolls, you should keep those receipts too for reimbursement purposes.

There is no required form to claim mileage or other out of pocket costs for reimbursement. A reimbursement request must be sent to the insurance carrier and must include the date you traveled, the location you went to, and the mileage to and from that location. Form C-257 can be used to submit mileage to the insurance carrier. That form can be found at here.

Also many times your medical providers can supply you with a listing of the dates and locations you attended treatment.

At Meggesto, Crossett and Valerino, we recommend that you submit requests for reimbursement promptly, going back no longer than six months from the date of your appointments. Older and lengthy requests take longer to be processed for payment by the insurance companies and often become the subject of a dispute. Please note that mileage not associated with treatment is not generally reimbursed, this includes mileage to hearings, the pharmacy, or your attorneys’ office. Mileage to an IME is reimbursable.

We also recommend you keep a copy of any submission you make to the Insurance carrier, including forms and receipts and also make a record of when you send in such paperwork. If you haven’t received a response within 60 days, you should contact your attorney for assistance in following up on the request.

For more information on workers compensation, click here.