How Do Workers' Comp Doctors Get Paid: What You Need To Know

A question we get from some of our clients is how do workers’ comp doctors get paid? We understand that many physicians cringe when they see a new patient under workman’s comp. They know getting medical treatment approved is going to be a challenge. Telephone calls to insurance companies go unanswered. There is no open claim letter to rely upon. The situation becomes even more dire when medical bills go unpaid. The patient needs additional treatment. Physicians typically give patients the benefit of the doubt and try to work with the situation. Here are some practical tips for dealing with workman’s comp insurance. How workers’ comp doctors can get paid.

Understanding the fee schedule

Michigan law has a fee schedule for procedures under workman’s comp. This is the most amount of money that can be charged to a patient. This is known as “cost containment”. It is not uncommon to see medical bills get slashed by more than 50%. All charges must be submitted on a proper claim form such as the CMS 1500 or UB-92. Balance billing is not permitted. Disputes with insurance companies must be resolved through the Workers’ Disability Compensation Agency. Never file a lawsuit in district court against a workman’s comp patient as this can create additional problems and backfire when trying to get paid.

Billing other health insurance

Patients who have their workman’s comp benefits disputed can use health insurance. This includes Medicaid and Medicare. Ask for a copy of the Notice of Dispute (Form WC-107) for confirmation. Copayments and deductibles are the patient’s responsibility under their respective plans. It will be up to the patient to reimburse these entities should they later obtain a workman’s comp settlement. We do not recommend keeping a balance in lieu of billing other insurance as settlement is never guaranteed.

Communicating with plaintiff attorneys

It is a good idea to cooperate with the patient’s attorney. Send unpaid bills on proper claim forms with supporting medical records. Nothing is more frustrating than trying to get workers’ comp doctors paid without knowing the total balance owed. Do not charge excessive fees to copy records or process claim forms. The attorney is trying to get medical bills paid and unnecessary charges end up slowing the process down and costing the patient.

Please resist the urge to send patients to collections. This creates additional stress. Usually results in less of a recovery. Ask the patient’s attorney to protect any unpaid bills in the workman’s comp case. Workers’ comp doctors should negotiate a discount. Ask to get paid directly from the settlement. Our experience shows that negotiated discounts are typically higher than what is paid under the fee schedule.

Physicians are frequently asked to give a medical opinion about causation and disability. Attorneys advance payment for these reports. Depositions but the patient is ultimately responsible. Do not charge excessive fees as this might discourage getting a formal opinion. Workers’ comp doctors should consider the cost-benefit of charging less for a report or deposition if it ensures medical bills get paid.