What doctors need to understand about workers’ comp and how to get paid.
A frequently asked question: 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 and there is no open claim letter to rely upon.
The situation becomes even more dire when medical bills go unpaid, and 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 workers’ comp insurance and how doctors can get paid.
Understanding the fee schedule
Michigan law has a fee schedule for procedures under workers’ comp. This is the most amount of money that can be charged to a patient. This is known as “cost containment” and it is not uncommon to see medical bills get slashed by more than 50%.
In Michigan, workers’ comp doctors get paid directly from the responsible insurance company, employer, or third-party administrator. 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 payers must be resolved through the Workers’ Disability Compensation Agency. We do not recommend filing a lawsuit in district court against a patient as this can create additional problems and backfire when trying to get paid.
Billing other health insurance
Patients who have their workers’ comp benefits disputed can use health insurance to pay their doctor bills. 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 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.
Please resist the urge to send patients to collections. This creates additional stress for the patient and usually results in less of a recovery. Ask the patient’s attorney to protect any unpaid bills in the workers’ comp case. Doctors can give a cash discount and ask to get paid directly from the settlement. Our experience shows that negotiated discounts are still 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 and depositions, but the patient is ultimately responsible. Do not charge excessive fees as this might discourage getting a formal opinion. Doctors should consider the cost-benefit of charging less for a report or deposition if it ensures medical bills get paid.
Are you a doctor in Michigan wondering how workers’ comp will pay you? Call our workers’ comp attorneys now!
If you are a doctor wondering how wondering how to get paid by workers’ comp, call now (844) 325-4743 or fill out our contact form for a free consultation to speak with one of our experienced attorneys. There is absolutely no cost or obligation. We’re here for you.
For more than 40 years, our lawyers have been helping people like you who have suffered from work-related injuries in Michigan. We understand the physical, emotional, and psychological hardships you are experiencing from your accident. We also have the skill, experience, and know-how to protect you and get you the best possible payout amount for your case.
To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.
Remember, every work injury claim is different and must be negotiated on its own merits. Do not accept any payout amount without fully understanding your legal rights.
Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 40 years. Call (855) 221-2667 for a free consultation today.
Related information:
Workers’ Comp Settlement and Medicaid: What You Need To Know
