| (a) An injured employee may request reimbursement from
the insurance carrier when the injured employee has paid for health
care provided for a compensable injury, unless the injured employee
is liable for payment as specified in:
(1) Insurance Code §1305.451, or
(2) Section 134.504 of this title (relating to Pharmaceutical
Expenses Incurred by the Injured Employee).
(b) The injured employee's request for reimbursement
shall be legible and shall include documentation or evidence (such
as itemized receipts) of the amount the injured employee paid the
health care provider.
(c) The insurance carrier shall pay or deny the request
for reimbursement within 45 days of the request. Reimbursement shall
be made in accordance with §134.1 of this title (relating to
Medical Reimbursement).
(d) The injured employee may seek reimbursement for
any payment made above the division fee guideline or contract amount
from the health care provider who received the overpayment.
(e) Within 45 days of a request, the health care provider
shall reimburse the injured employee the amount paid above the applicable
division fee guideline or contract amount.
(f) The injured employee may request, but is not required
to request, reconsideration prior to requesting medical dispute resolution
in accordance with the provisions of Chapter 133, Subchapter D of
this title (relating to Dispute of Medical Bills).
(g) The insurance carrier shall submit injured employee
medical billing and payment data to the division in accordance with
Chapter 134, Subchapter I of this title (relating to Medical Bill
Reporting).
(h) This section is effective July 1, 2012.
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