Workers Compensation and Acupuncture
PA Workers’ Compensation benefits, by definition, cover any medical treatment that is reasonable, necessary, and related to the injury of the individual while on the job. Determining what is considered reasonable or necessary for medical treatment can sometimes be difficult. Below is some information to clarify what treatments are covered by Pennsylvania Workers’ Compensation.
Choosing a Healthcare Provider
For the first 90 days, Pennsylvania workers are required to treat with a medical provider on the employer’s list of designated physicians. The list of healthcare providers must be prominently posted in an easily accessible area in the workplace. However, if none of the physicians on the list are qualified to deal with the person’s injury, the worker is allowed to visit a doctor of his or her choosing.
After the first 90 days of treatment have passed, the injured person can begin seeing a physician of his or her choosing. However, he or she MUST notify their employer within five days of the appointment or the employer will be voided of medical bill responsibility.
As mentioned above, any treatment that is considered reasonable, necessary, and related to the person’s work injury is covered by Pennsylvania Workers’ Compensation benefits. Common examples include physician visits, hospital stays, physical therapy, chiropractor visits, medication, and assistive devices.
Acupuncture is covered under Pennsylvania’s Workers’ Compensation as long as it is deemed “medically necessary”. Our office cannot determine medical necessity. If there is any question about this, your case may be sent up for review by an independent third-party reviewing organization. We am required to bill your Workers’ Compensation insurance company for you, however, you are ultimately responsible for the charges. If your Workers’ Compensation claim is denied for any reason, including lack of medical necessity, you will need to pay us for the services rendered. It often takes several weeks for your first bill to be processed, so you may accumulate many weeks worth of charges just to find out that your claim has been denied, sent up for review (a lengthy process) or otherwise delayed. So that this does not create a hardship for you, I encourage our Workers’ Compensation patients to set aside their payment amount in their own savings account. If your treatment coverage is denied, payment will be due immediately. By having the funds set aside, it will keep you from wasting any energy worrying about the outcome of your claim submission.
If you are considering alternative treatments, it is first important to consult with both your physician and your employer before moving forward.
If you have any questions regarding additional Workers’ Compensation, please to contact us.