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Workers compensation billing

crystalp 3 months ago in User Group Help updated by Richard Sethre, Psy.D., L.P. 2 months ago 1

Our clinic has been getting more clients who have worker’s compensation and with the limited experience we have we know we spend quite a bit admin time trying to obtain info of where to send claims and what to send plus it’s sometimes difficult to get payment. We have a couple questions: 

1. can you collect  money up front from the client in case WC doesn’t pay  or is there a rule in workmen’s comp about this? 

2. can you bill the insurance and not use workmen’s comp or is their a rule against this?

Does anyone had links to resources about WC billing?

Thanks in advance 

Greetings to crystalp and the rest of the user group interested in this interesting question.  Since, as far as I can tell, crystalp has not received a response, I'll take a stab at the question. 

If I understand correctly, the question is about benefits.  In other words, if the person seeking your services has filed a workers comp claim and been determined to have a work-related psychiatric injury, and has been awarded some coverage for mental health treatment, then the company that manages the workers comp insurance would be responsible for paying - it is a covered benefit for workers comp..  The person should be able to provide a document that states all of this, including who is responsible for paying - and how much.  You may or may not want to accept the person for treatment, based on the workers compt benefits (the rate of reimbursement, how many app'ts are covered or for how long, etc). 

On the other hand, if the person has experienced psychiatric problems as a result of work (stresses, abuse, trauma, etc) but does not have a workers comp award, then they should, I think, be able to access their medical insurance benefits for behavioral health - as long as their symptoms//ipairments meet the medical necessity criteria for their medical insurance policy. 

It might, I think, be trickier if they have a workers comp award but don't want to use it, and want to use their regular behavioral benefits for their medical insurance.  I think you would need to check with the insurance company to see if this is forbidden ("an excluded benefit") by the person's contract.  A more likely pattern, I think, would be that the person starts with their workers comp benefits and once they are exhausted then they move on to their medical insurance benefits.