House Bill 7, passed in 2005, offered Texas the tools we need to make drastic improvements to the our workers' compensation system. Transferring regulation of the comp program to the Texas Department of Insurance has had a positive impact.
Even though the physician fee schedule was improved, many physicians still do not participate in the program. Physicians simply cannot afford the additional burden and hassle created by the workers' compensation insurance industry.
The introduction of managed care networks has led to a surge in renting, leasing, and brokering physicians' contractual payment rates. Physicians discount their rates in exchange for steerage from the health plan. However, many services provided by non-network physicians in workers' compensation are being repriced without the physicians' knowledge. Documentation from the insurance carrier does not explain to the physician why his or her payment was reduced, and it is almost impossible to decipher the multitude of relationships that exist among carriers and third-party discount brokers.
Other strategies health insurers use to deny paying injured workers' medical claims include inappropriate use of treatment guidelines, last-minute scheduling of peer reviews, tedious preauthorization requirements, and arduous prospective and retrospective review to determine if physician payment is warranted.
These obstacles must be removed so physicians can provide needed care to injured workers. Health insurers' unnecessary interference only serves to keep physicians out of the system. Healthy workers are vital to the Texas economy, and injured workers deserve better.
Medicine's 2009 Agenda
- Support measures that improve communication between employers and physicians so the injured worker can return to work in a timely fashion.
Reduce administrative hassles by simplifying preauthorization and avoiding last-minute scheduling of peer reviews.
Prohibit third-party and discount brokers from trading physicians' contracted rates without the physicians' knowledge and consent.
- Support legislation that ensures non-network physicians receive appropriate payment for services provided to injured workers.
Texas employers pay high workers' compensation premiums relative to other states. They expect their employees' work-related injuries to be treated appropriately and efficiently.
Injured workers should be able to obtain clinically appropriate, cost-effective health care in a timely manner and within a reasonable geographic proximity. Any system providing health care to injured workers should be clearly defined, fair, simple to understand, accountable, and easily accessible by all parties involved.