Setteled Workers Comp Case

[Alice Scott]

Question
We have a patient that states his work comp case has been settled by way of section 32. And under the terms of the settlement we as the doctors are only allowed to charge the rate of $27.11 set forth by the NY work comp board. Our office visits are $30 each. The patient has not produced anything that states this rule to us and we haven't received anything from the insurance or the work comp board. Can we refuse to except the amount and charge him our regular fee?
Suzie

Answer
Hi Suzie,
   Are you still billing the comp carrier?  If you are billing the comp carrier then the fee schedule for a 99213 visit is $27.11 and that is all you can bill.  But this sounds like the patient has settled the case and accepted a settlement. 
   That means that the workers comp case is now closed and the patient has agreed not to make any more claims on that case. 
   That also makes the patient either a cash patient, or private insurance.  If you are no longer billing a comp carrier for a comp case, then you are not restricted to the comp fee schedule. 
   (Also, the patient settled, not the doctor. You didn't agree to the terms of the settlement.) 
 
Hope that clears it up.
Michele

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