24.29.2853 RIGHTS OF THIRD-PARTY PROVIDERS AFTER THE UEF REACHES $100,000 MEDICAL BENEFIT EXPENDITURE LIMITATION -- APPLICABILITY
(1) Providers of medical services, referred to in 39-71-508 , MCA, as "third-party providers", who are directly affected by the UEF's invocation of the $100,000 aggregate expenditure limit for medical benefits have a right to bring a legal action against the uninsured employer for unpaid charges for medical services furnished to the injured worker as follows:
(a) The UEF's payment of the amount allowed by the fee schedule constitutes payment in full for the charges for a given medical service. After the UEF has reimbursed all services that fall within its aggregate expenditure limit, a medical provider may pursue the uninsured employer for the full amount of reasonable and customary charges incurred for services rendered that were not reimbursed. The UEF will notify a provider to which services a given reimbursement applies.
(b) The uninsured employer has liability only for medical services directly related to those conditions arising out of the industrial injury or occupational disease which the UEF accepted as a claim.
(2) Pursuant to 39-71-508 and 39-71-743 , MCA, the injured worker is not liable to the provider of medical services for the difference between the amount payable to the provider pursuant to the fee schedules and the charges billed by the provider or for the services provided that are not reimbursed after the $100,000 expenditure limit is reached.
(3) This rule applies to claims arising on or after July 1, 2007.
History: 39-71-203, MCA; IMP, 39-71-503, 39-71-508, 39-71-510, 39-71-704, 39-71-727, 39-71-743, MCA; NEW, 2007 MAR p. 1446, Eff. 9/21/07.