Nebraska Orthopaedic and Sports Medicine is proud to serve individuals injured on the job. All of our physicians are experienced in diagnosing and treating work-related injuries. It is our goal to work with employees through the entire process so they can return to work recovered and healthy.
We pride ourselves on providing services to injured workers to ensure the treatment and recovery process starts as quickly as possible.
Patients with an open, disputed or litigated work comp claim may not use their personal health insurance for treatment or surgery nor can they choose to be self-pay. For claims with these statuses, we require work comp authorization for services prior to treatment.
For work comp claims that are closed, denied, or settled, we allow the patient to proceed with personal health insurance or as self-pay. However, the following is required:
- A letter from the work comp carrier indicating the claim is “closed”, “denied” or “settled”; it is not enough for an adjuster to say “we are not authorizing treatment.”
- The letter must include the patient’s name, claim number, date of injury and specific body parts.
- The letter must be on the work comp carrier’s letterhead.
If we are not informed by the patient at the time of initial treatment that they have a Worker’s Compensation claim and are treated under his/her personal health insurance, please note that this does not constitute that we will continue that practice. We may ask the patient to wait for further services until:
- The work comp carrier provides authorization for the treatment; or
- The work comp carrier provides the letter mentioned above.
If charges went to personal health insurance and they were denied, or if there is a balance out to coinsurance, deductible or copay, please note that these are 100% patient responsibility.
Please note that any outstanding balance for which the patient is responsible will be expected to be paid on a timely basis, regardless of attorney or court involvement. We do not wait for settlement of work comp claims and expect patients to pay their bill. If work comp pays later, we will promptly refund the patient and their health insurance carrier.
This policy was established to protect the patient from incurring charges they cannot or do not want to pay. Health insurance companies do not pay for charges that were a result of a work injury, and to submit a claim to health insurance and not indicate that it is a work-related could be construed as fraudulent.