workers' compensation preauthorizationWorkers’ compensation benefits should cover all of the medical treatment that you require when you are hurt at work. This does not mean, however, that workers can just go to any doctor they want and have every procedure they may need covered. There are restrictions on who you can receive care from and when you can change doctors.  There may also be certain treatments that the insurer does not agree to pay for.

For certain types of procedures, preauthorization for workers’ comp medical coverage is required.  You and your doctor will need to follow the procedures set forth by your employer’s workers’ compensation insurer to get these medical treatments paid for.  The preauthorization process should not result in the denial of legitimate medical care that your treating doctor believes  you need for your work injuries. If you are being denied care that you require in order to try to recover from workplace injuries, contact a Texas workers’ compensation lawyer at Abbott and Associates, L.L.C. for help.

When is Preauthorization For Workers’ Comp Medical Coverage Required?

If the workers’ compensation insurer providing your coverage has a network of providers, you are required to get care through that network or else you may not have benefits covered. If you need to go to an out-of-network doctor for any reason, you would need to seek preauthorization for workers’ comp medical coverage or the bills may not be paid. The only exception is in a serious or life-threatening emergency after the injury. When this occurs, you can get treatment by any licensed medical professional for the emergency care.

When you have a treating physician, you need to continue to see that treating doctor. If you want to make a switch to a different medical provider, you need to provide notice to the workers’ compensation insurer and the Texas Department of Insurance Division of Workers’ Compensation field office that is handling your claim must approve the switch.   You should get permission to change doctors before you receive medical treatment from a different treating provider.

If you need to see a specialist, your treating doctor typically has to get preauthorization in order for workers’ comp medical coverage to pay the bills for the visit with the specialist.

Workers’ compensation insurers also define specific procedures that doctors must get preauthorization for. The list of procedures can vary not just from insurer to insurer, but also from year to year as diagnosis codes change.  Some procedures that will commonly require preauthorization include:

  • Spinal surgery
  • Home health care aides or physical therapy aids
  • Repeat MRI and CT scans
  • Referrals to psychiatrists, psychologists, and social workers
  • Occupational therapy after a certain number of visits
  • Chiropractic therapy after a certain number of visits
  • Steroid or botox injections
  • Spinal injections

These are jut a few of the many procedures a doctor may need to get preauthorization for.  If you are concerned about coverage, or if you believe you are being denied access to treatments that you need, contact an experienced workers’ comp lawyer at Abbott and Associates, L.L.C. today.

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