Yes, if there is an authorization to treat.

Some of our physicians require a review of the records before accepting an IME or 2nd opinion. We will contact you to schedule and make payment arrangements when the physician accepts the appointment.

An additional year of sub-specialty training following Orthopedic residency. Fellowship training provides a high level of skill in a specialty area. Every physician is not equally skilled in all aspects of surgery. Complex repair of different body parts on one patient may require different surgeons within the same practice for best results.

As musculoskeletal (MSK) specialists, we frequently receive referrals as many as 30 days after an injury. Prior to that time, inadequate or inappropriate imaging has often been ordered in addition to therapy that is not being supervised by a physician. Often, our evaluation reveals a need for surgical repair that could have been performed much earlier. At this point, surgery may be more complex, and recovery may be longer because of delay in treatment.

Many employers believe that referring directly to a specialist may result in a rush to potentially unnecessary surgery. Practices like ours offer comprehensive services precisely to prevent that outcome. We have non-operative providers who are well-equipped to evaluate injury and offer conservative care like therapy when appropriate. If conservative treatment fails, transition to a surgeon can occur seamlessly with no delay in care to impede the outcome.

Our practice is eager to collaborate with employers to offer MSK urgent care services customized for their needs.

Physicians may receive inquiries from and have obligations to as many as 6 parties for one work comp episode of care: patient, employer, adjuster, nurse case manager, carrier’s attorney and patient’s attorney.

Often, the communication among these parties is not well-coordinated; thereby increasing the administrative complexity of providing workers’ compensation care.

Injured workers require some of the most complex repair and surgical skill of all patients we treat. Re-injury is prevalent in some industries, and repair is always more difficult the second or third time.  Treating with our physicians who are Board Certified and Fellowship Trained in their specialties provides increase expertise.

Each service rendered for a work comp patient must be approved by an adjuster in advance. Health insurance plans usually require prior authorization for higher cost services, not all services. There are inherent delays in providing care through Workers’ Compensation.

This information must be submitted to multiple parties for each visit. Patients, employers, nurse case managers and adjusters may all want copies of these documents. For other types of patients, a work note is only provided to the patient directly.

Dictation must be submitted with each work comp bill requesting payment in addition to providing it to the adjuster. The adjusters and bill review teams are often siloed and do not share information. Health insurance plans generally require dictation upon request only.

Additionally, the physician is rarely pro-actively notified when a claim is settled or deemed to be non-compensable. We discover it when we receive a claim denial often weeks after a settlement or dismissal. Meanwhile, a claim for the same service will be denied by private insurance until written proof of denial by the comp carrier is provided.

Varied forms and other questionnaires are routinely requested by adjusters, nurse case managers and/or attorneys. Health insurance plans rarely require questionnaires as a supplement to dictation.

Because the Workers Compensation Commission sets the maximum allowable payment rates for physicians and facilities, we are not able to negotiate rates directly with the purchaser that exceed those limits. 

Precisely because these complexities exist exclusively in workers’ compensation, our practice has a team of representatives to coordinate treatment with the appropriate stakeholders.