The great dilemma! Neither workers comp nor health insurance will pay for treatment.
The situation is all too familiar to the Maryland workers compensation attorney. The dilemma arises when an employee is injured on the job and is, by law, required to use workers comp insurance to pay for his or her medical treatment. From the first doctors appointment the medical providers are required by law to bill workers comp. Because of this, the health insurer will often refused to pay for any treatment. In many workers comp cases the initial treatment get authorized and paid for by workers comp and things run seemingly smooth. Then workers comp decides to start denying treatment.
Ordinarily the treatment that workers comp will deny is surgery, diagnostics, or extensive physical therapy. As a natural reaction to workers comp denying treatment, the injured worker contacts his or her health insurance and requests they authorize the particular treatment sought. The health insurance response: “its a workers comp case.”
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Maryland Workers Comp won’t pay, neither will Health Insurance! What to do?
Pay out of Pocket?
It is at this point the injured worker begins to feel helpless, devastated, angry, or confused. The next thought is to try and pay out of pocket so that they can get the treatment needed, get better, and return to work. This is a very noble thought and those that think of this should be commended for attempting to do what seems best. The unfortunate reality is that many physicians refuse to accept cash payments now days. The reasoning I can not comment on, however it does seem, especially with more expensive treatment, that there is a common refusal to accept cash payments.
Another issue with payment in cash could arise. The injured may believe that they can pay cash for the treatment and get reimbursed by either workers comp or health insurance eventually. In a great majority of cases this will not happen. Workers comp insurance pays physicians according to a fee schedule. Health insurance pays physicians according to a fee schedule. This means that the insurance providers, bother workers comp and health insurance, will pay at a lower rate than what is actually billed by the medical provider. That is a per-determined rate and not subject to increase. The amount the injured worker pays in cash, if permitted, will be at the full service rate and not the fee schedule rate. If any reimbursement is obtained it may be substantially lower than what was paid out of pocket.
Do I lawyer up to get health insurance or workers comp to pay for the treatment?
This is a good idea. If neither workers comp nor health insurance will pay for your treatment in Maryland then a workers compensation attorney can help get the treatment paid for. The good news is even if the Maryland work injury lawyer loses the workers comp case health insurance will then be responsible to pay for the treatment. An “Order” of the Maryland workers compensation commission will be issued finding the treatment either related to the work accident, or not related to the work accident. If the lawyer wins your case then Workers Comp will be forced to pay! Even in the unfortunate instance your case is lost at the Maryland Workers Compensation Commission health insurance will be required to pay for the treatment.