Introduction to Michigan workers’ comp fee schedule and how to choose a doctor.
Michigan law protects employees hurt on-the-job. It covers all reasonable and necessary medical treatment. This includes ambulance runs, emergency room visits, hospital stays, doctor appointments, medication, physical therapy, injections, durable medical equipment, and surgical procedures. There should never be any copayments or deductibles owed and it is a lifetime benefit. Here is some information about the Michigan workers’ comp fee schedule and how to choose a doctor.
What is the workers’ comp fee schedule Michigan?
In Michigan, the workers’ comp fee schedule establishes the maximum amounts that medical providers can be paid for treatment of work-related injuries. It covers all reasonable and necessary medical care required to treat a workplace injury, including doctor visits, hospital stays, emergency care, medication, physical therapy, injections, durable medical equipment, and surgical procedures. By setting standardized rates, the fee schedule ensures that providers are reimbursed while keeping overall costs for employers and insurers predictable.
While the rate chart covers most conventional medical services, some specialized or experimental treatments may require prior approval or additional authorization. Ancillary services, such as travel expenses for treatment or certain home health services, may also be subject to limitations. Importantly, patients do not owe copays or deductibles for covered services, and benefits continue for as long as medically necessary to treat the work-related injury.
Once treatment is rendered, state law regulates exactly how medical providers are paid. Providers receive fixed amounts based on the rate chart — a system known as “cost containment.” It is not uncommon for medical bills to be reduced by more than 60%.
All medical charges must be submitted on a proper health insurance claim form, such as the CMS 1500 or UB-92, for payment to be processed. Patients cannot be balanced billed for the difference between what is paid and what is owed. Medical payments under workers’ comp in Michigan are some of the lowest in the Midwest, largely due to the fee schedule. Over the last decade, the pure premium rate for employers has declined significantly, even though medical costs across the United States have risen dramatically.
Choosing your own doctor
Individuals collecting benefits have the legal right to select their own doctor after 28 days from the start of medical care. The only requirement is that notice be given to the insurance company. This can be done by sending a letter or email with the name and address of the new doctor. Sometimes it is necessary to pick-up medical records and deliver them to the insurance company.
Doctors are stuck with fixed amounts under the Michigan workers’ comp fee schedule. This is a fact regardless of their knowledge, skills, or experience. It does not seem fair, but it allows individuals to pick the best doctor possible. Don’t let the insurance company dictate which medical provider must be used because cost should be the same.
Doctors are sometimes hesitant to accept patients
Our experience shows that doctors are sometimes hesitant to accept patients under workers’ comp. They do not want to accept lower payments under the fee schedule or risk a potential dispute. It can take months or even years to force a insurance company to pay medical bills.
A very real concern with the Michigan workers’ comp fee schedule is that patients who need medical care will be sidelined. This is because payment amounts are so very low. Medical providers are still businesses who must justify which patients they can or cannot accept.
Without prompt payment, injured workers may face delays in necessary treatments, which can slow recovery and prolong disability. An experienced attorney can help ensure medical providers are reimbursed properly and advocate to keep care proceeding on time, protecting both your health and your benefits.
Injured on the job in Michigan and have questions about the workers’ comp fee schedule? Call our attorneys now for a free consultation!
If you are injured on the job in Michigan and have questions about your workers’ comp claim and fee schedule, call now 855-221-2667 or fill out our contact form for a free consultation. 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 Claim Denied: Now What Do I Do?
