Yesterday, we answered some important questions about workers’ comp. Today, we talk about the advantages and disadvantages of using PPOs or managed care to treat injured workers.
When an employee is injured on the job, workers’ compensation laws say that you’ll be paying for the medical care of the employee. This means you have decisions to make in terms of how to handle medical treatments in these instances.
In the BLR webinar entitled “Workers’ Comp 101: What HR Must Know,” Susan Fahley Desmond, attorney and expert in labor and employment law, outlined the primary advantages and disadvantages to using PPO and managed care for these treatments.
Advantages:
- Using a PPO or managed care can narrow the field of doctors the claimant can see to a select few.
- It can allow you to negotiate lower fees.
- It can also promote better communication between physician and employer to keep the employer updated on all medical developments, including maximum improvement, ability to return to work, hospitalizations, surgeries, refusal of treatment, etc.
- You can develop a relationship with treating physicians.
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- Doctors have more familiarity with the employer’s business (some may even visit the facility) and can draw on that knowledge for making informed decisions. An example of such a decision would be whether or not the injured worker can return to work.
- You probably tend to trust the doctor more, which would probably reduce the need for independent medical examinations, denials, etc.
Disadvantages:
- If a doctor is too close to an employer, then the employee might be less trusting of the “company doctor.”
- Some commissioners might be less inclined to allow independent medical examinations to take place, or alternatively, give the claimant more leeway in changing physicians or obtaining a second opinion, particularly if they suspect that the employee was not adequately apprised of his/her right to choose a doctor from the network.
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