How Does Workers Comp Pay Doctors

  • Posted on: Apr 29 2022
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Many times, the question of how workers comp pays a doctor is asked by a client involved with a workers comp claim. Many times a doctor who sees a workers’ compensation patient will be hesitant to see them. The reason is that getting the payment for providing treatment will not be easy. Often, a call to the insurance company may not be answered. The doctor will likely not have any claim documents available to submit.

Not being able to contact the insurance may even make matters worse, such as the bills remaining unpaid and the patient requiring follow-up. Often, a doctor will not blame the patient and continue to provide necessary treatment. For the doctor to be paid by workers comp, there are a few things to be aware of first.

Being Familiar with the Workers Comp Fee Schedule

Many states may have a workers comp fee schedule that doctors must follow regarding procedures they conduct. The fee schedule represents the max amount chargeable to the patient. If the cost is higher than a fee schedule amount, it will likely be cut in half. When a doctor makes a claim for payment, it must be made using form UB-92 or CMS 1500. If a dispute arises, they must have it settled with their state agency covering Workers’ Disability Compensation.

Requesting Payment from Private Insurance

If your workers’ comp patient uses their private insurance for treatment, then submitting a payment claim directly to the insurance carrier can be made. Ensure that the dispute form is obtained by the doctor conducting the treatment. When a settlement is received, the patient will be responsible for the payment.

Getting Ahold of the Attorney for the Plaintiff

As you give the patient’s attorney a call, it must be understood that you should cooperate with them as much as possible. Make sure that the claim forms are completed fully and have appropriate medical documents along with them. By submitting the claim forms in full, the doctor is able to be fully paid what they are owed. Refrain from charging for administrative processes, which may slow the process. Forgo making any collection effort against the patient. This will only lead to a recovery amount that will be significantly less. It is essential to have the medical bills protected as part of the case.

Discounts should be sought by the doctor seeking payment and have the payment sent to them out of any settlement amount. A lot of times, when a discount is negotiated, it will be a higher amount than what the fee schedule will state. Frequently, a doctor will need to provide an opinion concerning disability. When these opinions are obtained, the doctor will be compensated. Despite this, it is essential that the fees are not in excess because it may delay obtaining an opinion.


When a doctor needs to see a workers comp patient, there may be several stressful situations for the doctor as they try to get paid. By getting ahold of us today, we will explain the entire process of getting paid from workers comp.

Posted in: Blog, Orthopedics, Work Injuries, Workers Compensation Benefits

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