One of the most frustrating things for the Maryland injured worker, physicians, and attorneys- getting medical bills and treatment paid for
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For the Physicians:
There are some benefits for treating physicians that accept workers comp insurance in Maryland otherwise no doctor would be willing to accept workers comp insurance. For one, some of the treatments are paid at a higher rate than those through ordinary health insurance coverage. This means that doctors are paid more for the same service when workers comp is billed versus, say, billing Blue Cross or Cigna. A copy of the Maryland Workers Compensation Fee schedule can be found on the Commission website. Another benefit, business growth and exposure to unique injuries. The downside, actually getting paid. Physicians throughout Maryland that accept workers comp have regularly been cheated and not paid for services they have already rendered. This places an undue burden on the doctor to attempt to bill the health insurance, and in some unfortunate cases they may be forced to bill the employee.
Maryland physicians that do accept workers comp insurance should know a few things about getting paid. First, if a bill goes unpaid a physician or medical facility may file a Claim for Medical Services. This form can be filled out and sent to the Maryland Workers Compensation Commission and possibly lead to payment of the medical bill. The Commission will generate a Notice to the workers compensation insurer who will then either pay or challenge. In many circumstances the medical bill is simply paid! If the insurance company chooses to challenge the payment they will file a Controversion of Medical Claim and a hearing before the Maryland Workers Compensation Commission will be scheduled. While some attorneys that represent the injured employees are more than happy to attend a hearing to get the physician paid, others are not. Familiar to the physician, the attorney would not be paid for this work.
For the injured employee:
There is nothing more frustrating to the injured worker than having to deal with pain that could be reduced or prevented altogether if they could just obtain regular and uninterrupted medical care. Any injured worker that has dealt with Maryland workers comp for any extended period of time has likely experienced this.
Take the all to common scenario of physical therapy being approved for a short length, 7 visits perhaps. The employee makes progress starts to feel better, then is further sessions are denied. Three to six months down the road the workers compensation attorney is able to get authorization by going to a hearing before the Maryland workers comp commission.
Another common scenario with Maryland Workers compensation cases is when the injured worker exhausts all avenues of treatment except surgery. The doctor and patient/worker decide that surgery is the best chance at getting better. Low and behold the surgery is denied and the injured worker must wait a period of time to get authorization. If there is a Maryland workers compensation attorney involved they can help speed this process up, but it still takes far to long! Often this waiting period results in the loss of any benefits the injured worker may have received from therapy.
Perhaps the most frustrating experience for the injured worker is receiving a bill in the mail for medical treatment that they thought was being covered under workers comp or health insurance. Medical care is expensive and many injured employees may have opted to avoid treatment if they knew that in the end it would cost them thousands of dollars. For those with health insurance, this is left often the case because if workers comp denies treatment then the health insurer will likely step in and pay. For those hurt and without health insurance, a great deal of caution should be used before seeking treatment.
For the Attorney:
Workers Compensation attorneys in Maryland regularly go to hearing to make sure that bills are paid and treatment is authorized. In most circumstances there is no avenue for attorney’s to be paid when the issue before the Commission is only medical treatment. In some cases, this could mean the attorney is going to hearings on a regular basis for years before receiving payment.
In the end, a qualified and experienced attorney is more than willing to go to a hearing without pay if it means getting their client treatment and minimizing the pain.