Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation

One of the obstacles to incorporating medical tourism into workers’ compensation is the issue of Employee vs. Employer choice of treating physician. State Workers’ Compensation laws recognize four different categories of choice of physicians, Employer Only, Employer/Insurer, Employee/Employer and Employee Only.

Employer Only is self-explanatory; Employer/Insurer means that either the employer or his insurance carrier can choose the treating physician for the claimant. Employee/Employer means that the employee has the choice to choose the treating physician, or failing to do so, gives that right to his employer. Employee Only means that the employee can choose his physician.

Among the fifty states and the District of Columbia, a slim majority of states allow some form of employer choice as described above, and as indicated in Figure 1. As seen in Table 1, choice of physician is marked by an ‘X’ under each category for all fifty states and the District of Columbia.

Figure 1

Table 1

The percentage of states for each category is shown below in Figure 2, the majority of states, 48% recognizing Employee choice, but if you add together the Employer Only, Employer/Insurer and Employee/Employer categories, the majority of states would favor employer choice in whole or in part.

Figure 2

What this all means for medical tourism is this, the best approach to take in implementing medical tourism into the US workers’ compensation system is to get employers to choose it as an option for their injured employees who will need secondary treatment, i.e., surgery that would be more expensive in the U.S., but at a much lower and more reasonable cost and better quality in fully accredited hospitals in medical tourism destinations.

For self-funded employers, especially those already using medical tourism as an for their employees health care plan, doing the same with their workers’ compensation claims will allow them to realize considerable savings in workers’ compensation costs, as they are ready realizing in their health care costs. Employers, who are getting coverage on health care for their employees through the commercial market, will want to approach their workers’ compensation carriers to get them on board with a medical tourism option. Some commercial insurance companies that provide both health care coverage and workers’ compensation coverage would be the best companies to work with in this regard.

If there is some resistance on the part of employers and their insurers because of state workers’ compensation laws, then a concerted effort to amend, remove or change these laws will need to be considered, not just by a few companies, but across the board in the business world. To do anything less would be to allow the status quo to continue and to see medical costs for workers’ compensation claims to rise even higher when there is a viable and reasonable alternative available, within a relatively short distance from the US mainland in Central and Latin America, the so-called “rising stars” of medical tourism.

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This entry was posted in Health Care, Medical Tourism, Workers' Compensation and tagged , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

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