WCRI Study – Health Insurance Medical Treatment More Economical Than Workers Comp
The health insurance vs Workers Comp medical treatment costs have long been a concern for employers, carriers, and TPA’s.
Medical costs for Workers Compensation claims have always been seen as very expensive when compared to Health Insurance. WCRI (Workers Compensation Research Institute) recently conducted a study that compared Workers Comp claim medical costs with health insurance claim costs.
The states that were covered in the study are at the end of this article. The study compares hospital outpatient payments made by workers’ compensation and group health for treatment of common surgical cases in 16 large states, which represent 60 percent of the workers’ compensation benefits paid in the United States.
The study covers hospital outpatient services delivered in 2008. As there were very few changes since 2008 in the medical fee schedules for the states in the study, the numbers should be considered almost, if not completely current.
Medical costs are slowly increasing to the level of 2/3 of the Workers Comp costs in certain states. Most of those are states without fee schedules. Even the states with fee schedules are feeling the effects of increased medical costs. Medical claim costs in excess of 70% of total claims value will be the norm if the recognized trend continues for a few more years.
One of the more stark figures in the study is that Workers Comp carrier pay 43% more for the same medical procedure than if the claims were filed with health insurance. The medical procedure studied was outpatient shoulder surgery.
One question the study abstract posed is the difference in outpatient surgery costs necessary to induce outpatient facilities to treat WC patients? My answer to that has always been WC pays very well for medical procedures. I have rarely seen any medical practitioner turn away WC patients regardless of what a fee schedule would pay for rendered services.
The following 16 states are included in this study: California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin.
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