You would think that scheduling a workers compensation doctors appointment would be pretty easy. After all, you just call and schedule an appointment to see the doctor when you get sick.
Unfortunately, the Georgia workers compensation system makes it a little harder than just using your health insurance. Before we talk about that further, I want to provide a little background on medical treatment covered by workers compensation in Georgia.
What medical treatment does workers compensation cover?
Workers compensation pays for the medical treatment you need for your work injury. You do not have to pay any co-pay or deductible for that medical treatment.
Georgia workers compensation law limits your choice of doctors. But, those doctors can provide you pretty much any medical treatment or testing you need for your injury.
While that is a simple summary of workers compensation medical treatment, there are many details that are important. You can find a number of articles discussing specific details about your medical treatment rights on this page.
If workers compensation covers my medical treatment, why is it difficult to schedule a workers compensation doctors appointment?
That is a good question. The problem with scheduling a doctors appointment originates from payment for that medical treatment.
Like everyone else, doctors work for a living. They need to receive payment for the services they provide. So, they often want to know how you will make payment when you schedule a workers compensation doctors appointment.
Most people use some form of insurance when they go to the doctor. After a work injury, you will use the workers compensation insurance to cover your medical treatment.
When you try to schedule an appointment, the doctor’s office will probably want to know the name of the workers compensation adjuster or case manager. They will try to get approval from the insurance adjuster.
Unfortunately, many doctor’s offices will even require that they receive approval from the adjuster before scheduling the appointment. Often, the insurance company does not provide that approval.
When you try to schedule an appointment, the doctor’s office may tell you that they have to have a form filled out by your employer. The doctor’s office might schedule you an appointment but tell you they will cancel that appointment if they do not receive approval from the insurance company beforehand.
As a result of all this, you often do not receive the medical treatment you need promptly.
Does Georgia law require the insurance company to give approval to the doctor’s office?
Unfortunately, Georgia law does not currently require the insurance company to give the doctor any answer when the doctor calls and asks for approval. Some insurance companies use this in their favor to delay and deny your medical treatment.
What can I do to get a workers compensation doctors appointment scheduled?
First, just try to call the doctor’s office and schedule an appointment. This may work fine. The doctor’s office may just schedule the appointment.
But, what if that does not work? Hopefully, the doctor’s office will contact the insurance company and get approval. Even though this may happen, you probably need to try to help out.
You can call the insurance company. Try to talk to the insurance adjuster or case manager. Tell them that they need to call the doctor’s office and provide approval for your appointment.
When you do this, you probably want to document your efforts. Sometimes, the adjuster will not answer the phone or respond to emails. Making notes about your efforts to get approval can help you later.
What if I need help getting my medical treatment?
I wish I could say that it was easy for you to get the medical treatment you need after a workers compensation injury. Unfortunately, many people find it difficult.
Even those people who do not have difficult getting an appointment scheduled often run into a problem when the doctor wants to perform an expensive test or surgery. If you have difficulty getting treatment, you may also find it helpful to read this article about how to beat medical treatment delay and denial.
I would also suggest that you reach out to me or another attorney that specializes in Georgia workers compensation for a free consultation about your case. A free consultation will provide you with information tailored to the specific facts of your case.
