Can My Doctor Bill Me for Medical Treatment Found Not Reasonable and Not Necessary by a Pennsylvania (PA) Utilization Review?

No. Work related medical bills from the work injury not paid by the employer of the workers’ compensation insurance that were found to be unreasonable and unnecessary by a utilization review can not be charged or billed to the injured worker. Under the PA Workers’ Compensation Act, Section 127.211 (b) of the Rules and Regulations states that: (b) A provider may not bill for, or otherwise attempt to recover from the employee, charges for treatment or services determined to be unreasonable or unnecessary… A practical problem is that the Workers’ Compensation Act does not provide for a way of stopping doctors who bill their patients for a work-related injury. You should ask your lawyer to contact the doctor and point out the language of the Regulation and take further steps if need be.