Solutions to Common Problems
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How to Make Insurers Pay the Doctors
On July 2, 2008, the Workers’ Compensation Board announced a clarification of the effects of the amended WCL §54-b, which in turn deals with the steps necessary to force a carrier to pay medical bills, steps which are not in and of themselves complete.
In Subject No. 046-207, the Board wrote that,
“The neglect or failure of a carrier or self–insured employer to pay awards for medical bills in a timely manner has a significant impact on the ability of all injured workers to obtain effective and immediate treatment, as it discourages health care providers from seeking or retaining authorization to treat workers’ compensation claimants. Additionally, it may result in the health care provider seeking direct payment from the claimant, despite the statutory prohibition against direct payments. A claimant’s ability to obtain proper medical treatment expeditiously not only benefits the claimant, but also results in lower medical costs for employers. Claimants who receive prompt and proper attention are more likely to be able to return to work swiftly and less likely to have long term disabling conditions.”
For years the WCB had made available to the providers of medical service the HP-1 form which should be submitted when the health provider has been unsuccessful in obtaining payment from a carrier for more than 45 days after the services have been rendered to the claimant. This form, in use since 1997, replaced an earlier version in effect since 1994. Unfortunately, the carriers have since 1997 treated the new HP-1 with the same concern they did with the earlier HP-1 form issued in 1994: they would often ignore it. Hence the new HP-J1 form and the July 2, 2008 announcement.
But, in The Insider’s opinion, this is like telling a child who has stolen a cookie that, unlike the first time when you were ‘angry’, this time you are ‘really angry’. This process also places the burden on the medical provider to file pages and pages of HP-J1’s every week or so, when the deadline has passed so that they do not have tens of thousands of dollars in unpaid bills before filing the HP-1/J1 or awaiting the largess of the carrier before they get paid.
But in reality there is a far simpler method, one which relieves the doctors of the need to file HP-1’s and HP-J1’s every few weeks.
In the above Subject Number, the Board writes “The continued viability of the workers’ compensation system is substantially dependent upon voluntary compliance of all parties with the Workers’ Compensation Law, rules and regulations of the Board, and legal responsibilities imposed upon the parties.”
But what does the WCB mean by ‘voluntary compliance’. Although the firms, profit and non-profit, may have ‘volunteered’ to be in the insurance business, they are all also authorized to do business in the State of New York, some authorized by the WCB itself. After all, not every company can meet the requirement to qualify as an insurer.
So, if they cannot meet the obligations they have ‘voluntarily’ agreed to in order to make or save money as a carrier of record, the WCB should revoke or suspend that authorization when the number of HP-1’s or HP-J1’s reach a certain level, in terms of absolute quantity or dollars or some ratio of complaints to cases or whatever.
If 100 doctors file claims under §54-b against Carrier X, why should doctor #101, #102, ad nauseaum also have to file. Why can not the WCB and/or the Department of Insurance contact the carrier with a warning to pay ‘everyone’ or risk suspension or revocation.
As a commissioner I had asked this question of the administration and some legislators and have yet to have anyone tell me that this idea is wrong and/or mention any problem with it. I am usually greeted with a “Hmm, that’s interesting.” In fact I was told not to bring it up a pre-board meeting at which the commissioners are supposed to be able to discuss what they feel are relevant issues or to ask questions so that they can learn more about the system.
So, now that I have a soap box web site, I am asking, “Why doesn’t the WCB use its authority to revoke a self-insured’s right to self-insure if there are enough complaints about its failure to pay its medical bills?”
