Do All Workers’ Comp Medical Procedures Have to Be Pre-Approved?

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An on-the-job injury can put tremendous pressure on you and your family. In these cases, there’s often more to consider than just medical bills. You may need to take time off work and this can impact your ability to meet basic expenses, such as food, rent, and utilities.

Fortunately, most employers in Georgia are required to provide some form of workers’ compensation benefits to their employees. Workers’ comp is a type of insurance that can help an employee that is injured on the job with healthcare and rehabilitation costs. It can even provide for lost income during the time that you are unable to work.

However, the workers’ comp process has a lot of red tape. One of the limitations to the program is that you don’t necessarily get to choose which provider you visit for medical treatment. In most cases, you cannot simply go to your family physician and then expect to get fully reimbursed for the care.

Instead, you must follow the specific procedure provided by the workers’ comp board. Failure to do so could result in your medical bills not being covered.

The Process After an Injury

Time is a factor when it comes to on-the-job injuries. For that reason, it is important that you report your injury to your employer as soon as possible. If you wait longer than 30 days, you may lose your right to receive any workers’ comp benefits.

Pre-Approved List of Doctors

Now, you may be accustomed to making an appointment with your family doctor when you have an injury or illness. However, workers’ comp works different and you are only allowed to visit doctors that have been pre-approved by your employer.

In Georgia, your employer is required to provide you with a list of at least six doctors. This list must be posted in an accessible place, such as a break room. Note that the doctors on the list are the only ones you may visit for medical care following a work-related injury.

However, the process is a little different if your employer goes through a Workers Compensation Managed Care Organization (WC/MCO). This company is certified by the workers’ compensation board and your employer will need to provide you with a 24-hour toll-free number for the WC/MCO. Your employer will also need to furnish you with a list of eligible medical service providers. By calling the number for the WC/MCO, they can help you schedule a medical appointment with an approved provider.

Note that you can change your doctor at any time without the approval of your employer. But, the new physician must be on the list of eligible providers.

Bear in mind that if you have an injury that requires immediate medical attention, you can visit the closest emergency room. In other words, urgent care does not need to be offered through a medical professional from the list. However, any follow-up care must be obtained from an approved doctor.

Payment of Medical Treatment

The benefit of following the workers’ comp procedures correctly is that you can have all of your medical bills covered. This includes all bills from doctors, hospitals, physical therapists, prescription costs, and some necessary travel expenses.

Note that all procedures you receive must be first authorized by your treating physician.

Your physician will need to make a referral if you need to see a specialist, such as a physical therapist.

As mentioned, prescription drugs are generally covered. However, in some cases, there are additional procedures that must be followed. For example, you may have to front the cost of medication and then wait for reimbursement benefits. You can always check with your workers’ comp administrator if you are unclear about this process.

Further, if you have any problems getting your medical expenses covered, it can be helpful to reach out to a workers’ comp attorney.

Pre-Authorization from Employer Required

In most cases, the attending physician has the authorization to make treatment recommendations. This gives your doctor the option to order additional services or consultations without the prior authorization of your employer.

But, it is important to understand that any tests and services requested must be related to your on-the-job injury. If the services are not related, they may require pre-authorization or not be covered at all. For example, it might be the case that you had a pre-existing condition that complicated the injury. If further tests or services would be required because of that pre-existing injury, they may not be covered on your employer’s policy.