A little help understanding.

[lolipop2004]

Hello, I am new here. I don't quite understand how all of this workers comp stuff works. It seems to be really confusing and everyone is telling me different things. ( case worker, personell manager, and dr's)

I live in Texas and I got injured on the job. I choose the dr I wanted to see. I then found out that he doesn't except workers comp, but no one ever explained to me in the beginning that he needed to accept it.

Now I am going to start seeing a dr who does take workers comp. My question is should I get money back since I already paid for my dr visits? I am on a payment plan with that dr, so even though I was told that I could no loner see that dr, I still have to pay him the rest.

Do you normally not get reimburst if you pay out of pocket?

Thanks for your help

[1171]

the whole purpose of insurance is for them to pay so you don' have to.
are you sure the employer has workers comp?
you should find out more information before taking action or making decisions.
you can start here
http://www.tdi.state.tx.us/wc/indexwc.html

[Lilly]

You should have been given a claim # from the insurance company, IF your injury was not denied

Lilly

[lolipop2004]

When I got hurt at work, they told me that I could go to there dr, or chose my own. I choose my own dr. What no one told me upfront is that the dr, that I choose would have to accept workers comp.

so now I still owe him the money, but I am now currently seeing a dr that accepts it.
I have my claim number now.

[nauticalgurl1]

Did you choose your own doctor because he accepted YOUR insurance?

[cnaz]

Each state's way of handling WC is different, but if you have a claim number and your claim has been accepted then the medical expenses should be covered. Do you have a point of contact eiter with your employer, insurance carrier etc? If so, ask them how you would submit medical service claims. You should be able to submit the doctor's note and the billing along with your claim number and be reimbursed.

Although our expenses were covered from the begining some bills ( especially radiology services who bill seperately from the Dr or Hospital) were sent to us or our regular health insurance, once sent to the adjuster they covered them.

I was in shock, the first day I came back from the hospital to get it ready for hubby to come home from hospital ( ramps, bathroom equip, hospital bed etc) and in the mail that day was the air ambulance bill - $15,999! After my inital panic I got it worked out by the insurance adjuster and they paid it.

I hate to admit it but as much as WC makes our lives miserable, the medical coverage was sooooooooo much better than our personal coverage, we would have exceeded our max benefit amount in a very short period of time and had tens of thousands of out of pocket expenses between co-pays, deductibles and max benefit amounts.

[lolipop2004]

No, I didn't choose that doctor because my insurance would cover it. I chose that doctor because a friend referred me to him.

When I called my workers comp rep, she said that they don't give money back, they said if you pay out of pocket they don't give it back. I don't understand why they wouldn't give the money back to me, because I paid it.

The new doctor that I have does except the workers comp. He has me on the same terms as my old doctor ( the one who didn't except the insurace) .

My question is since I normally work 9 hours a day, but now they have me working only 4 hours a day. Will workers comp pay me for the rest? Or does workers comp only pay the medical bills when your injured?

Thanks

[lolipop2004]

CNAZ,, wow that is a lot of money.. I am glad everything worked out for you.

It seems like all of this workers comp is so confusing.



Thanks everyone for your replies and help.

[kate]

Texas Rule 133.270 sets down what you need to do for reimbursement. http://www.workerscompensation.com/regul...346&title=

They still may refuse based on you choosing a doctor that does not accept work comp. Did anyone tell you anything about who you could choose? Were you given any documentation (pamphlet, etc.) regarding your rights and responsibilities prior to going to the doctor?

[AQA]

When I first got injuried, I went to my own dr. for treatment. A week latter I was in the er. Once the WC claim was accepted, I sent copies of what I had payed for co-pay and meds. to the IC and they payed me for my out of pocket expences.