How Workers’ Comp Doctors Get Paid

If you’ve been injured on the job in Maryland, you are already dealing with a lot. Between the doctor visits, paperwork, and insurance phone calls, you also need to figure out how to make ends meet while you recover. But one thing matters most: getting the care you need to heal.

Workers’ compensation doctors are an important part of this process. They evaluate your injury, guide your treatment, and help determine when you can return to work. But have you ever wondered how workers’ comp doctors are paid?

This is more than the money. You will want to know how the system works and how it could impact your care.

How Workers’ Comp Doctors Get Paid?

In Maryland, workers’ comp doctors will not send you a bill for your visits. Instead, they will bill the workers’ compensation insurance company that covers your employer.

The state has rules about how much doctors can charge for certain procedures and services. They are detailed in a fee schedule created by the Maryland Workers’ Compensation Commission (WCC).

For example, if you need an MRI for a back injury. The fee schedule sets the maximum amount a doctor or facility can charge for that scan. Even if these professionals normally charge more for the same service through private insurance, they must stick to the workers’ comp rates.

Under this system, the costs are kept under control. The WCC makes sure injured workers can access care without worrying about the price tag.

How Long Does It Take for a Doctor to Get Paid?

In most cases, these healthcare professionals get paid by the workers’ compensation system within 30 to 60 days after they submit their bills. However, this can take longer, depending on a few factors.

Insurance companies need time to review the medical records, make sure the treatment is necessary, and confirm it is linked to the injury. Payments can be delayed if there’s any disagreement over whether the treatment is covered. In these situations, the WCC might step in to help resolve the issue, which can take even more time.

While the system should be quick, delays are common.

Can This Affect Your Care?

Since the fee schedule sets lower rates than private insurance, some doctors hesitate to accept workers’ comp patients. Also, specialists, like orthopedic surgeons or pain management doctors, are in high demand in the healthcare industry. In turn, they prioritize higher-paying cases. This can make it harder for you to find a doctor who is both qualified and willing to take on your case.

Doctors treating workers’ comp patients have to deal with several processes to get paid. They need to submit detailed documentation to the insurance company and often to the Maryland WCC.

Everything must be outlined, including progress notes, treatment plans, and justifications for every test or procedure.

While this helps with accountability, it can lead to delays in getting treatment.

Unfortunately, workers’ compensation insurance companies do not always pay doctors right away. Sometimes, it might take weeks or months to process a claim. If the insurer disputes whether the treatment was necessary or related to your work injury, the doctor might not get paid at all until the dispute is resolved.

For that reason, doctors might become hesitant to take on new workers’ comp patients.

What Does That Mean for Injured Workers

Maryland’s system is designed to protect injured workers, but sometimes, it can make people feel stuck in a lot of red tape. This can lead to:

• Limited choices: You might find that certain doctors are not willing to accept workers’ comp cases.
• Delays in treatment: If the insurance company needs extra time to approve a procedure or resolve a dispute, it can slow down your recovery.
• Added stress: When trying to heal, the last thing you need is more stress. Unfortunately, proceeding through the workers’ comp system can feel overwhelming at times.

How a Workers’ Compensation Lawyer Helps

A workers’ comp lawyer can help you find doctors familiar with Maryland’s workers’ comp system. Along with that, they can advocate for timely approvals for your treatment.

If an insurance company denies a procedure or delays payment, they can step in. These professionals will work with your doctor to gather the right documentation, challenge unfair decisions, and make sure you are not left waiting for the care you need.

Whether it is explaining why your treatment was delayed or walking you through the appeal process, your lawyer will be there to answer your questions and ease your concerns.

At Belsky & Horowitz, LLC, we are here to help during this stressful time. Under the workers’ comp program, you deserve fair treatment and high-quality care. If you are struggling with these hurdles, we can provide you with the legal guidance needed to overcome these obstacles.