How Are Medical Providers Paid For Workers’ Comp Claims In Maryland?

How Are Medical Providers Paid For Workers’ Comp Claims In Maryland?

The workers’ compensation system in Maryland ensures that injured employees receive necessary and reasonable medical care for covered work-related injuries and illnesses. Once your workers’ comp claim is approved, your employer or is workers’ compensation insurance provider should pay for your medical care. You should not incur any fees for your medical treatment. However, you need to ensure that the physician you choose accepts patients for treatment for workers’ comp claims. The state regulates payment for medical services related to a workers' compensation claim.

Workers’ Comp Medical Fee Schedule

The Maryland Workers’ Compensation Commission (WCC) publishes a fee schedule that details how much a medical provider may receive for medical services. These fees are based on the average cost charged by providers for services within Maryland.  The fees are often lower than the provider charges other patients and third-party insurance providers. If a provider agrees to accept workers’ comp cases, the medical provider cannot charge fees in excess of the fee schedule.  The medical provider cannot charge you for the difference between the billed amount for services and the amount paid pursuant to the Medical Fee Schedule.

Out-of-State Medical Providers

Unfortunately, the Medical Fee Schedule does not apply to medical providers outside of Maryland. Furthermore, the workers’ compensation insurance provider is not required to pay fees to out-of-state medical providers that exceed the Maryland Medical Fee Schedule. Therefore, if you move out of state while receiving treatment for an injury or illness covered by workers’ comp, you should be aware that you may be responsible for the cost of care that exceeds the Maryland Medical Fee Schedule. You can return to Maryland for treatment, but you are responsible for the travel expenses to and from your new residence.  The workers’ comp carrier is only required to reimburse you for mileage from your prior residence in Maryland to a Maryland medical provider.

Seek Legal Assistance if There is a Problem

If you are not receiving the medical care you need or you believe there is an issue with the payment for your medical care, contact Pinder Plotkin at 410-525-5337 to request a free consultation with a Maryland workers’ comp lawyer. Check out more information in these relevant blog posts:  Chapter 5 - How Do I Get Paid for My Workers' Compensation Claim Chapter 4 - Your Right to Medical Treatment After a Workplace Injury Chapter 3 - How Do I Report an Injury at Work? Chapter 2 - Who is Covered by Workers' Compensation Insurance in Maryland?  Chapter 1 - What is Workers' Comp?
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