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Workers Comp Medical Cost Confusion – Wisconsin Is Now Highest


Wisconsin – Workers Comp Medical Cost

I was finishing up my last post on Workers Comp medical costs. I had a research that proved Virginia was the highest in the nation. I then read this article and now I am confused. I think the Augusta Journal article that I referenced was incorrect in my original post. I violated one of my rules in this post – look at the study behind the data.

The Insurance Journal was correct in saying that Wisconsin is the highest state for other than hospitalization medical costs. Virginia was number two on the list. The article I am referring to is the one from WCRI.

Map of Wisconsin Workers Comp Medical Emblem
(c) 123rf.com

According to the WCRI, Prices in Wisconsin for non-hospital services were more than twice that of the 25-state median, and nearly 50 percent higher than the median of the six states with no fee schedules. Even if you ignore the fee schedule states, Wisconsin is still extremely expensive for medical treatment. The E-Mods for employers in Wisconsin are where this will show up in the most dramatic fashion. I am unable to say how much more a 50% medical cost figure would impact the Mod, but it is a heavy factor.

For my last article on this subject, I am wondering how many of the 10 most expensive states are fee schedule and non-fee schedule. I will cover that next week.

The bottom line to all the medical costs comparisons is that the top two states do not have fee schedules. After working in or consulting in basically all 50 states, I can tell you that a fee schedule can help your Mod (E-Mod or X-Mod) drastically.

Pill Capsules Workers Comp Medical On Paper Currency

Unless I am mistaken, most of the non-fee schedule states are U&C (Usual and Customary). U&C may look good on paper as your company can usually receive drastic cuts to the bills. However, the bottom line bill charges are still more than the fee schedule states.

If your company, TPA, or insurance carrier has a PPO network agreement, you can save even more money off the fee schedule rates or the U&C rates. If you are unsure if you are receiving your PPO discount, pulling a few medical bills that are processed and examining them will indicate whether or not you are in a PPO network. The usual PPO discount is 15%.

I always recommend accessing a few of your Workers Comp medical bills and going line by line. By the way, how much are you being charged for medical bill processing? You could be in for sticker shock.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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