Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation

Further research into the topic of Employee vs. Employer choice was prompted by a phone call I received over a week ago from an attorney in New York who handled workers’ compensation cases and is a consultant to carriers and businesses on workers’ compensation, group health and disability insurance, cost-containment, claims investigation and claim preparation. The call got me to think about what I had previously stated in my earlier post on the subject of employee vs. employer choice, and to my amazement, new research found that New York State allows employees, and not their employers, to choose the treating physician. I corrected my error in the original post, but decided that a further clarification and elaboration was needed.

Needless to say, when I came across a study by the Texas Department of Insurance comparing state workers’ compensation systems, I found more information, and decided to expound upon my previous writing. What I found was not just that there is employee vs. employer choice, but that choice of physician is determined by six additional categories. The first category is employee choice of physician. The second category is selection from a list prepared by the appropriate state agency. The third category is selection from a list maintained by the employer. The fourth category is employer choice. The fifth category is employer’s choice may be changed by state agency, and the final category is a after a specified period of time, choice falls to the employee.

As seen in Table 1, thirty states allow some form of employee choice of doctor, while twenty states allow some form of employer choice of doctor. This is important to bear in mind, for the purposes of incorporating medical tourism into workers’ compensation, as 60% of U.S. states allow employees to make the initial choice, and only 40% of U.S. states allow employers that choice, as seen in Figure 1, so that in order to incorporate medical tourism into workers’ compensation, it will be necessary to get employees to agree to it before getting their employers, or their employer’s carrier to do so.

Figure 1 – Pct. of Employee/Employer Choice

Table 1 – State-by-State Comparison of Statutory Provisions Relating to Choice of  Treating Doctor

Source: Texas Department of Insurance, Workers’ Compensation Research Group, Comparison of State Workers’ Compensation Systems, 2004.

Note: * If an employer and/or insurance carrier has a managed care arrangement for workers’ compensation, then injured workers are required to choose a treating doctor from within the employer’s or carrier’s network.

Note: ** If employer has designated at least two Health Care Organizations (HCOs), then the timeframe that an employer has to choose the treating doctor is normally extended.

Broken down even further into the three categories mentioned above for employee choice, as well as for employer choice, 24 states allow employee to have initial choice, which represents 80% of all states that allow employee choice. Four states allow the employee to select from a list prepared by the state agency, which is 13% of all thirty states, and three states allow employees to choose from a list maintained by their employer, which is 10% of all the employee choice states, as seen in Figure 2.

Figure 2 – Pct. of Employee Choice Categories

Ten states allow employers to choose the treating physician. Three states allow the employer’s choice to be changed by the state agency, and seven states allow the employee choice of doctor after a specified period of time has elapsed. As shown in Figure 3, half of the twenty states that allow employer choice, or 50%, allow for initial employer choice. The other 50% is split between states that allow the state agency to change the employer’s choice (35%), and the states that allow the employee to choose after a specified period of time (15%).

Figure 3 – Pct. of Employer Choice

To further complicate the matter, one state in the employee choice category, yet unknown, allows the employee to choose their treating doctor if they can prove that they or a family member has a record of previous treatment with a particular doctor. As shown in Table 1, five states allow workers to choose their doctor if the employer or carrier does not have a managed care plan; otherwise they have to choose from within the network. Seventeen of the employee choice states have unlimited choice of treating doctor, but are not ascertained in the report.

It would appear that in order to incorporate medical tourism into workers’ compensation, it would be useful for any facilitator or other entity such as an employer or carrier, to carefully read the statutes in each state they are conducting business in and have considerable workers’ compensation claims that might benefit from the lower surgical cost and quality issues medical tourism affords. To not do so would be foolish, and would create a great deal of confusion and doubt as to the whole efficacy of medical tourism, which would be a terrible mistake for the employee, his employer and the insurance carrier.

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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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