4123-7-04 Claimant reimbursement.

In cases where the claimant pays for medical services or supplies directly to a health care provider who does not accept assignment as defined in rule 4123-7-30 of the Administrative Code, or if any other person or payor, including a volunteer, makes the payment on behalf of the claimant, and the claim or condition is subsequently allowed, the bureau shall reimburse the payor upon submission of evidence of the service or supply and evidence of the payment for that service or supply. The payor will receive as payment the usual, customary, and reasonable amount that would have been paid by the bureau or self-insuring employer to the health care provider as provided by the rules of this chapter. Where the bureau, in good faith, has already made the payment to the health care provider, the payor shall be informed by the bureau to seek reimbursement from the payee.

Upon request, the bureau shall inform a claimant or payor whether a health care provider has agreed to submit fee bills to the bureau for direct payment and assignment as provided in rule 4123-7-30 of the Administrative Code.

Replaces: 4121-17-04, 4123-07-04

R.C. 119.032 review dates: 10/27/2004 and 03/01/2009

Promulgated Under: 119.03

Statutory Authority: RC 4121.12, 4121.30, 4121.31, 4123.05

Rule Amplifies: RC 4121.121, 4121.44, 4123.66

Prior Effective Dates: 1/1/78, 11/13/92