Do The Insurance Companies Call The Shots When It Comes To Doctor Visits?

No, but unfortunately, a lot of doctor's offices think so. Here's how it works when you're on DC workers compensation.

Concentrated Young Woman Patient Visiting Doctor General PractitionerFirst, you can choose your own treating physician - that is your right under the D.C. Workers Compensation Act, so don't let the insurance company tell you otherwise.  Sometimes the adjuster or nurse case manager will tell you that you need to select from a panel or that they have a list of approved doctors to choose from.  Make your own choice - get a referral from friends and relatives or call us to see who our clients like and how a lawyer can help you in your case.

Doctors Are Not Required To Get Authorization For Each Visit, But Sometimes They Will Insist On It

Once you choose that doctor, they do not have to get every appointment authorized by the workers comp adjuster - this is a big waste of time, and many adjusters won't even do this.  Adjusters won't call back or fax a form to the doctors office in time for your appointment.

 But sometimes the doctor will cancel the appointment if he doesn't get this pre-approval. Doctors don't like to have their bills go unpaid, and like you they go to great lengths to avoid setbacks from the insurance company. They fear if they don't have pre-authorization, they could get their payments denied or delayed.

In reality, all the doctor has to do is send the bill and report to the adjuster for payment after he sees you. Specific treatment and tests - surgeries, MRI, physical therapy, etc. need to be approved, but this doesn't apply to routine visits with your treating physician.

Having Trouble Getting The Medical Treatment You Need? 

Call us at (202) 393 - 3320 to get the answers you have been searching for. We make it easy to get started and provide income stability and consistent medical treatment after a serious injury.

Frank R. Kearney, Attorney-at-Law
Connect with me
Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer