As I begin the week and look at my upcoming docket of hearings, I am once again amazed (and not in a good way) of the number of hearings concerning treatment issues. Unfortunately, the managed care organizations (MCO’s) continually deny needed treatment and the Bureau of Workers’ Compensation rubber stamps their decisions leading to the need for a hearing on multiple treatment issues. Unfortunately, this for profit managed care system is now out of control and the only ones getting rich are the managed care organizations while the treating doctors and injured workers suffer!
In Ohio, state funded employers have the right to choose which managed care organization will medically manage their injured workers claims. The treating doctors must request authorization for any and all treatment through the managed care organization and the paperwork they need to complete for authorization is endless. Often, the doctors must dedicate a full-time staff person just to deal with the workers’ compensation patients and the MCO’s. Because of the endless paperwork and red tape many of the primary care doctors in Ohio have left the workers compensation system. Family doctors simply cannot afford the time, money, or luxury to assign a dedicated person to handle with this paperwork nightmare.
For the doctors who remain in the workers compensation system, there are endless fights on treatment issues. The treatment is reviewed and often denied leading to appeals and reviews by MCO paid physicians and rarely is the request for treatment once denied ever overturned by the MCO appeal (ADR) process. Once through the internal MCO review process the issue goes to the BWC and is usually rubber stamped. Only then, after filing yet another appeal is the issue set for a hearing before a hearing officer.
If the doctor and injured workers are perseverant and make it to a hearing (filing all the necessary and timely appeals), the hearing officers will often grant the treatment relying on the injured worker’s doctor who has examined and treated them over the course of time, rather than rely on the MCO paid physician reviewer who has never seen the injured worker.
All the while, the injured worker goes without treatment while this chess match is played out in the workers’ compensation system. Not only does this often lead to permanent injury and disability, but also hurts both injured workers and employers because it increases the time off work and compensation paid during that time.