Last month I discussed medical treatment rights stemming from a compensable Maryland Workers’ Compensation claim. Since medical costs are controlled by the Maryland Workers’ Compensation system, you never have to pay anything for treatment required for injuries sustained as part of your compensable claim – with one catch – the treatment must be in Maryland.
Medical bills of health care providers who provide treatment outside of Maryland are not controlled by the Maryland Workers’ Compensation system. Therefore, in those circumstances you may have to pay a portion of the costs for treatment you need for injuries sustained as part of your compensable claim. The amount you will pay is the difference between what the medical provider charges and the amount the Maryland fee schedule requires employer/insurers to pay.
What should you do?
Most of the time obtaining treatment is not a problem. Since many Workers’ Compensation systems have fee schedules, as does Medicare and private insurance plans, health care providers will often agree to reduce their charge to the Maryland fee schedule rate.
However, you must ask before the treatment starts, not after the bill arrives! Otherwise it may be too late.
It has been my experience, with few exceptions, that out of state health care providers accept the fee schedule. When they refuse, it has also been my experience that the Maryland Workers’ Compensation Commission will not order the employer/insurer to pay more than the fee schedule unless the treatment required is unavailable in Maryland and is clearly required by the claimant this does not mean a new speculative procedure not yet approved in the United States.
An additional problem is presented when an injured worker receives medical treatment outside the United States. This is because it is the injured worker’s responsibility to provide employer/insurers all medical reports and bills. The bills must be coded in a certain manner and the reports must be in English. The burden to provide documentation is not an insurmountable stumbling block, but it is a frustrating one that often causes extensive delays when the treatment is not in the United States.
By Clifford B. Sobin, Esq.