For many claimants, the goal of filing a claim is ultimately to “get the White Card” … with the expectation that once you have been approved and received a ‘White Card” that everything going forward will be hunky-dory. Well, as many learn, that is rarely the case. There are many issues that come up which require constant vigilance and follow up with a worker’s various medical providers.
This blog is one of several I am publishing in the hope that the facts and myths are more universally known. In this post, I will discuss Expense reimbursement related to services that you have to pay out of pocket for, or for personal travel to and from medical appointments.
First – There are two forms, OWCP-915 & OWCP-957. The former is for direct out-of-pocket expenses, and the latter for travel reimbursement. These forms are available for download from the main DEEOIC web site or from your regional DOL DEEOIC Resource Center. There are instructions on the forms for both, but basically, every time you submit a claim for reimbursement, it should include one or both.
DOL prefers/requires that submissions should be for services provided in the same month, not spread out over time, and one form for each provider. These same forms are used by the Federal Department of Labor, Office of Worker Compensation Programs (OWCP), and for our purposes, the Division of Energy Employees Occupational Illness Compensation Program. OWCP handles Black Lung Disease and two other Federal worker programs.
Second – In terms of what additional document(s) you are to provide along with a completed form, I use the analogy of the “expense report sandwich”. You should present all supporting documents as if the recipient knows nothing as to what your approved medical condition(s) are. And then the following:
a) one page outline/summary of who you are, your CaseID, contact info, description of service(s) requesting reimbursement for
b) proof of the service (medical record(s) confirming it was for you and the type/scope of services
c) copy of original invoice that also documents/references the same service/service dates, and
d) proof that you paid out-of-pocket.
The primary mailing address for submitting expense reports and supporting documents is:
P.O. Box 8304
London, KY 40742-8304
Now, this may seem like overkill. But sometimes it is better than counting on the billing/tracking system your medical provider uses to display “all” the info necessary on as few pages as possible.
As to d), proof you paid, this is not simply a credit card statement showing an amount and payee. It should be a receipt from the medical provider showing that service(s) have been paid, and it should line up with the other provided documentation. I have had some workers request the “clean” invoice, and then another copy of the same AFTER payment is made/applied.
Keep a copy and record of every submission. If you are just starting out with this program, I suggest submitting your first one or two requests directly to one of the DOL Resource Centers, requesting staff review your submission and advise over the phone as to what is missing or could be done differently.
On Paying Out of Pocket
Seeking reimbursement for co-pays on medical services is straightforward if you follow the instructions above and provide complete documentation as to what was paid by a 3rd party insurer and the amount you paid.
It is also an option for a worker to pay out of pocket for actual medical services. The concern is whether DOL OWCP will reimburse you at 100% of your out-of-pocket for all services. With appropriate documentation, and for services that are clearly related to your approved condition(s), perhaps there will be no issue. However, this can be problematic when different services (CPT codes) are provided under the same bill, and it is not clear which are related to the approved condition or not. At times, you may need to request from your provider an invoice which details all services provided AND a medical doctor’s statement/letter that such services (need to be specific) were medically necessary and related to your approved condition.
My advice is to be careful believing and expecting DOL to reimburse you at 100%. There are often issues. One action you can take in advance is to request a pro forma bill/invoice (or schedule of treatment/services for the next 90-180 days) for the planned services and send a note with that information to your DOL Claims Examiner for “pre-approval”. This can take some time to get a response. If you get a letter back green lighting the expense, then you should be fine when you submit for reimbursement, following the outline above, with a copy of the approval letter.
Referrals to Other Providers
Another common issue is the expectation that when your primary medical provider refers you out to another facility/provider for tests or other services, which are presumed to be related to, or preventative for, your approved condition, that such services will automatically be covered by the “White Card”. As an example, if you are referred out to a Radiation Oncologist, or to an Imaging Center for a periodic checkup, often these are operated as distinct, separate businesses, and the same rules/guidelines for billing apply for this additional Medical Provider. You need to double check that the alternate provider a) accepts the white card also, and b) that the referral from your primary physician clearly notes your approved medical condition and ICD 10 code … because that approved code must be included on all bills from all providers. For more information on the ICD 10 codes, refer to this blog post.
Hello – I am Al Frowiss from AtomicWorkers.com. We are an independent Advocate and Representative for current and former Energy Employee workers and their families.
In our practice, we strive to set appropriate expectations for our clients. Use of the ‘White Card” is the most important value a worker may receive from this program. As well, this is one of the largest areas of frustration and disappointment. However, knowing the rules of the EEOICPA process and how medical provider billing processing works, gives us the confidence to “know” what to expect, and how to take proactive action to minimize future billing issues. If you would like to learn more about how AtomicWorkers can help, please contact us directly. We return calls and emails promptly.