Capitated health insurance plans seen as a future cost driver for workers’ compensation and what this could mean for Michigan employers.
Business Insurance published a fascinating article about capitated health insurance plans. These types of flat-fee insurance plans are becoming more common under the Affordable Care Act and pay a fixed amount for each patient regardless of how much care is actually provided.
There is a concern that medical providers are going to game the system by classifying more soft tissue conditions as workers’ compensation. This would allow medical providers to get fee-for-service payments and higher amounts.
“Patients covered by capitated group health plans were 11% more likely to have their soft-tissue conditions called work-related,” according to a WCRI study. This could have a profound effect on states like Michigan where 22% of workers now have capitated group health insurance plans.
Our 2 cents
Cost-shifting and workers’ compensation is nothing new. A 2012 study published in the Journal of Occupational and Environmental Medicine found workers’ compensation premiums were artificially low. Almost 80% of costs are paid by group health insurance, Medicaid, Medicare, and other payers.
Our clients struggle everyday with getting reasonable and necessary medical treatment approved under workers’ compensation. Proving the injury is work-related can sometimes be a challenge. This is especially true with soft-tissue injuries that might not have been promptly reported to an employer.
We are skeptical that more capitated health insurance plans will truly lead to higher workers’ compensation costs in Michigan. Give us your thoughts in the comments below.
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 35 years. Call (855) 221-2667 for a free consultation today.
Photos courtesy of Creative Commons, by Bill David Brooks.