Tag Archives: employee choice

Washington State Workers’ Comp Accepts Foreign Medical Providers

Seven years ago, when I was working on my MHA degree, I wrote a paper which has become the basis of this blog.

During that time, I found the website of the Department of Labor & Industries for Washington State, and was surprised to find landing pages that listed physicians in Canada, Mexico, and other countries. These countries were mentioned in my paper, and I have referred to it in subsequent posts from time to time.

However, in the period since, I have noticed that the landing page for other countries was removed. I contacted WA state a while back and was told they were updating it. Yet, as of recently, it is still not been replaced, so I contacted them again yesterday.

I received a reply from Cheryl D’Angelo-Gary, Health Services Analyst at the WA Department of Labor & Industries. She indicated in her response that she is the business owner of the Find a Doctor application (FAD).

According to Ms. D’Angelo-Gary, “our experience showed that most of Washington’s injured workers who leave the country travel to one of these adjacent nations. Workers who travel further afield are advised to work with their claim manager to locate (or likely recruit) a provider. All worker comp claims with overseas mailing addresses are handled by a team of claim managers who have some extra training to help the worker find a qualified provider.”

I asked her to clarify this statement further in my next email by asking if this means that any claimant who travels outside of North America will have to ask the claims manager to find them a doctor.

She replied, “interesting questions!” She also differentiated between an injured worker who is traveling versus one who has relocated out of country.

She went on to say that, “a worker who is traveling and needs claim-related care would be instructed to seek treatment at an ER or urgent care clinic, where the providers do not need to be part of our network and would not be providing ongoing treatment. To be paid, the provider would have to send us a bill and a completed non-network application (available online). Under no circumstances should the provider bill the worker.”

However, she continued, “a worker who has relocated overseas must send in a change of address (required whenever a worker moves). That allows us to transfer management of the claim to a unit that specializes in out-of-country claims. The claim manager would work with the injured worker to help the worker find somebody in their new location. It’s critical (per state law) that the worker choose their own provider, though the provider must meet our requirements and standards of care. Proactive workers tend to handle this well, and find a provider in very little time; less proactive workers can find this challenging. We’re currently looking at this process to see how we can do this better.”

And in final emails to her last night, I tied the first scenario to medical travel, and the second scenario to ex-pats living abroad, but needing medical care. I also asked about workers who wanted to travel back to their home country for medical care, and said that I write about medical travel for workers’ comp.

As of today, I have not heard back, but it is early, and there is a three-hour difference between us.

It must be pointed out that WA state is what is termed a ‘monopolistic state’ in that the state does all the work of handling workers’ comp insurance and claims. Thus, when Ms. D’Angelo-Gary says that worker must work with the claim manager, the claim manager in question is a state employee, and not an employee of a commercial insurance company.

It may be possible, therefore, for medical travel to be implemented in workers’ comp, and it should be something that the medical travel industry and the state should explore together. Ms. D’Angelo-Gary did say they were looking at this process to do better. What better way to improve the process then by utilizing medical travel?

An Old Topic Returns

Back when I began this blog, I discussed in several posts, the difference between employee and employer choice of physician in each state for workers’ comp.

As reported last week, and elaborated here by Peter Rousmaniere, there is some question as to whether the choice of doctor affects costs.

I’ll leave it up to you to decide what is true.

Employer Choice States See Lower Claim Costs

Introduction

When I started this blog three years ago, one of the first topics I covered was the issue of employee/employer choice of treating physician (see “Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation” and “Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation“).

Then in March of this year, ProPublica’s Michael Grabell and NPR’s Howard Berkes, wrote an article called, “The Demolition of Workers’ Compensation“, which was a first in of a series about the workers’ compensation system.

In the article, Grabell said that in 37 states, the worker cannot choose his doctor, or they are restricted to a list provided by their employer. This statement generated some concern from the industry.

My fellow blogger, Joe Paduda tried to get them to see both sides, but gave up the effort when it did not result in any discussion between them, as he wrote about the following day, calling the reporting a “public disservice”.

The next day, I wrote to Mr. Grabell, and told him that his facts were wrong. He told me in his response that he relied on data from the US Chamber of Commerce.

I told him that the WCRI and the state statutes were a more accurate source of information. My email thread covered eight messages that day. I provided him with the data I used in the articles cited above, and in the presentation I gave the previous November in Mexico.

Lower Costs When Doctor is Chosen By Employer

Business Insurance’s Stephanie Goldberg today reported on a study published in the latest issue of the Journal of Occupational and Environmental Medicine, that found that the average medical cost per work comp claim is lower in states where the employer chooses the worker’s initial treating physician.

Average medical costs were $308 lower in those states where the employer can choose the treating doctor for employees with low back pain, than in states where the workers were allowed to choose, Goldberg reported.

The study, sponsored by the Liberty Mutual Research Institute for Safety, said that states limiting treating provider change had higher medical costs than states that allow a one-time change.

There was however, the study found, no significant difference in average medical costs between cases in states that limit initial change and states that don’t, according to Goldberg.

Employers participating in a managed care organization, preferred provider organization or coordinated care organization in states like California and Florida, are allowed to to direct care. States like Arizona and Massachusetts allow workers to chose their providers.

The study also found, that the average medical costs ranges from $1211 in New York to $4514 in Texas, and length of disability ranged from 19 days in Missouri to 69 days in Texas.

The study was compiled using more that 59,000 low back pain claims between 2002 and 2009 from 49 jurisdictions, including Washington, DC, and did not include North Dakota and Wyoming.