Wiki Can Worker's Comp PT pay cash?

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Blackhorse

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One patient has extreme back pain and wants to have an 64483 but Auth. has been denied by WC. She wants to pay cash. UR from WC wants to set up P2P with the MD, and they have tried to call the MD many times and unable to get hold of him. Can we take cash from WC patient?
 
The answer is yes, for California.

This answer is always a surprise to workers comp adjustors. I have explained more times than I can count to adjustors that workers comp cannot deny treatment, only deny PAYMENT for that treatment. Once workers comp has decided that they are not going to pay for something, the patient is free to obtain it through any other means available to them, whether that is with insurance or cash. I recall one time asking an adjustor, "Do you REALLY think you have the power to forbid a patient from obtaining medical treatment that has been recommended to them by a DOCTOR???"

The thing the adjustors don't like, which I am happy to point out, is that the commercial insurance company is likely to come after them for payment anyway.
 
SharonCollachi said:
The answer is yes, for California.

This answer is always a surprise to workers comp adjustors. I have explained more times than I can count to adjustors that workers comp cannot deny treatment, only deny PAYMENT for that treatment. Once workers comp has decided that they are not going to pay for something, the patient is free to obtain it through any other means available to them, whether that is with insurance or cash. I recall one time asking an adjustor, "Do you REALLY think you have the power to forbid a patient from obtaining medical treatment that has been recommended to them by a DOCTOR???"

The thing the adjustors don't like, which I am happy to point out, is that the commercial insurance company is likely to come after them for payment anyway.
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Really? It's nice to know. If PT choose to pay cash, we won't bill WC but we still need to send doctor's note to WC, right?
 
A word of caution from someone on the commercial insurance side of the industry for 20+ years. If the treatment is related to a work comp covered injury, the commercial insurance company may deny the claim for the treatment that the UR for the W/C carrier attempted to do a P2P on without successfully making contact with the provider.

You may eventually get the commercial carrier to pay, but it will likely take a number of appeals to get paid. There is also a realistic chance that they will deny it as related to a work comp covered condition and the UR for the W/C carrier attempted to complete a P2P in order for the procedure to be authorized.
 
CBLENNIE said:
A word of caution from someone on the commercial insurance side of the industry for 20+ years. If the treatment is related to a work comp covered injury, the commercial insurance company may deny the claim for the treatment that the UR for the W/C carrier attempted to do a P2P on without successfully making contact with the provider.

You may eventually get the commercial carrier to pay, but it will likely take a number of appeals to get paid. There is also a realistic chance that they will deny it as related to a work comp covered condition and the UR for the W/C carrier attempted to complete a P2P in order for the procedure to be authorized.
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Thank you so much(y)
 
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