“I Can’t Get No, Satisfaction”
California Industrial Medical Treatment is controlled by the Labor Code. Thus, it differs from both traditional Private Medical Care as well as Government Programs such as Medicare and Medicaid.
Industrial medical care is part of a risk management system designed to provide cost-cutting elements with respect to providing the service.
Researches have looked into Injured Workers’ satisfaction with respect to their treatment.
This article will discuss Injured Worker’s satisfaction with their medical treatment.
What is Industrial Medical Care?
In California, Industrial Medical Treatment is guided by the Labor Code. The Labor Code contains various treatment limitations.
Medical Control is one limitation. Insurance Company Managed Provider Networks limit the doctors that Injured Workers can choose.
Medical treatment is limited by utilization review of medical treatment requests. These utilization reviews can deny treatment that does not follow the set algorithms and schedules.
What Is Private Medical Care?
Private Medical Care can come from a variety of sources. There is cash payment in where there is a direct provider patient relationship. There are personal insurance policies for which the individual purchases the policy directly from the medical insurance company. Finally, there is employer provided health insurance policies.
What is Medicare?
Per the SSA, “Medicare is [the U.S]… health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.
The program helps with the cost of health care, but it does not cover all medical expenses.”
What Is Medicaid?
Per Medicaid.gov, Medicaid programs [are] designed to provide health coverage for low-income people. This program is separate from Medicaid.
Can Injured Workers have Multiple Insurance Coverages?
Yes. Injured Workers can have multiple coverages at the same time. It is possible that an Injured Worker can have private coverage, medicare and workers’ compensation at the same time. For Injured Workers with low income and are on social security disability, they may have medicare, medicaid, and workers’ compensation at the same time.
What was the Study’s Overall Finding? Were There Other Findings?
The study found that “that Workers’ Compensation status is independently associated with dissatisfaction with health care compared with other primary payer groups.” Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003
The study, however, had other findings of interest as well.
Workers’ Compensation treatment rated lower than Private Insurance and Medicaid. It did, however, rate at about the same level of satisfaction as Medicare. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.
With respect to mental health issues, workers’ compensation treatment, satisfaction was rated lower than private insurance. It was however comparable to both Medicare and Medicaid patients. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.
There was one area in which there was some higher level of satisfaction with respect to industrial medical treatment. This was when the treatment included surgical authorization. Patients with Workers’ Compensation who were scheduled for a surgical procedure were more likely to be satisfied with their care. Patients with surgical authorization have higher levels of satisfaction. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003
What Can Be Done to Improve Care Injured Workers’ Satisfaction?
This author believes that the following items may improve the level of satisfaction of industrial medical care. First, expanded Managed Provider Networks with more doctors to choose from. Second, improvement of the utilization review process to allow for greater authorization of treatment.
As noted above, Injured Workers are happy when there are results that occur as part of the treatment. This is shown in their level of satisfaction with respect to surgical authorization.
What If I Need Advice?
If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.