When Workers Comp Patients Settle

October 1, 2008

Our practice treats workers compensation patients, who often end up settling their case for a lump sum of money rather than opting for ongoing medical treatment. Once we have been notified that the patient’s case has been settled and the patient is seeing us on a cash basis, do we charge the patient what the workers compensation insurance has been paying all along for the patient’s visits? Some of us think that because the settlement figures are based on what has been paid by workers comp in the past, we should continue to charge the patient what workers comp has allowed all along. Others see the individual as being a self-pay patient and think we should charge her the same amount (much less than workers comp allowables) as the rest of our self-pay patients. Should we charge this patient what his workers compensation has paid in the past or is this seen as discriminatory by charging self-pay patients different amounts?

Question: Our practice treats workers compensation patients, who often end up settling their case for a lump sum of money rather than opting for ongoing medical treatment. Once we have been notified that the patient’s case has been settled and the patient is seeing us on a cash basis, do we charge the patient what the workers compensation insurance has been paying all along for the patient’s visits?

Some of us think that because the settlement figures are based on what has been paid by workers comp in the past, we should continue to charge the patient what workers comp has allowed all along. Others see the individual as being a self-pay patient and think we should charge her the same amount (much less than workers comp allowables) as the rest of our self-pay patients.

Should we charge this patient what his workers compensation has paid in the past or is this seen as discriminatory by charging self-pay patients different amounts?

Answer: We checked in with management expert Karen Zupko, of Chicago-based Zupko and Associates, who offered this opinion:

“I think a lawyer needs to rule. If the patient settled based on comp rates, then I’d charge comp fees. If the practice provided its regular fee schedule - which may be different from what they charge self-pay patients - it should use that as the basis for charging the patient.” Consult an attorney to be sure.