Workers' Compensation Discussion Forums

I was wondering if anyone besides me is having a problem being paid the workman's comp fee schedule. We are getting hit with "your claim was priced using your "Aenta WC access " contract. We do not have such a contract. I have sent certified letters demanding they either prove we have a contract with Aetna or send the rest of our money.
Anyone know what my next step would be to enforce this? Is there someone to report to?

Paula, what state are you in? I am not sure I understand the problem, as it might be a process unique to your state. I assume you are you the employer? Is this a rebate of some sort?

No...we are a physician's office. We are treating work comp patients. There is a state mandaded fee schedule (tennessee is where we are) and when we file a medical claim to the insurance carrier, they are not paying us the fee schedule amount...example...say we charge 500.00 for a 99455. The fee schedule allows 450.00. This is what we should be paid. However, they are hitting us with an Aetna workers comp discount and paying only 110.00. We do not have a contract with Aetna workers comp. I have sent them a letter telling them we do not and to prove that we do (which by law they have to do) and they are ignoring my letter. I'm looking to find out who governs these payers such as the insurance commissioner or whoever that I can call and report this

Ok - In Tennessee the Workers' Comp Division is part of the Department of Labor & Workforce Development. It sound like they may have your practice mixed up with another one. You can find a list of phone numbers here.

http://www.workerscompensation.com/tenne...acts01.php

Also, if your phone calls fall on deaf ears, try your local state Senator or representatives office. They can sometimes get a government wonk's attention quicker than you can.

Thank you for your help. I will work on that Monday. If you have ever heard of "silent ppo's" this is sort of like that. Where you might be contracted with one insurance and they lease other networks and hit you with those discounts also.

Paula if you are not a part of thier PPO -network or contract then they should be honoring your charges to the fee schedule. In TX the WC commission has a medical division that deals with thess issues. I would suggest you check into that and file the appropriate complaint or appeal on the pay decision they used to cut your fees.
Good luck!

Tenn. Medical fee information;
http://www.state.tn.us/labor-wfd/wc_medfeebook.pdf

Also login, for Tenn medical fee data;
http://ecmats.state.tn.us/MFS/

http://www.state.tn.us/labor-wfd/wcomp.html

You may want to call the agency and see if they have a procedure to collect the bill.

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