If you’ve been injured at work, your number one priority is getting back to full health. One of the best ways to do this is by visiting a doctor, undergoing an evaluation, and determining and following through with a treatment plan. That’s easier said than done, because the insurance company isn’t just going to give you carte blanche to get any medical procedure you want, because they are the ones footing the bill.
When it comes to getting medical care, the standard in Minnesota is that you are covered under workers’ compensation for medical care that is deemed “reasonable and necessary.” But how do you know if your medical care reaches that threshold? We take a look at some examples of reasonable and necessary care options in today’s blog.
Reasonable and Necessary Medical Treatments
Before we begin, let us preface this by saying that although the following treatments are often considered reasonable and necessary, that does not mean that they are always viewed this way. If you have questions as to whether or not a procedure or visit will be covered, speak to your workers’ compensation lawyer or contact the insurance company directly.
Here are some types of treatments that generally meet the criteria for reasonable and necessary:
- Appointments and doctor check-ups
- Diagnostic testing for injuries related to the work accident
- Required hospital stays
- Prescription medications
- Surgeries to address the work injury or to prevent a potential disability related to the work accident.
- Assistive medical devices
- Physical therapy
- Recommended treatment options by your care provider
A good rule of thumb to consider is that your care will likely be covered if it is basic in nature, or if it could help save the insurance company money in the long run. For example, physical therapy is almost always covered because it can help you reach your maximum recovery, which in turn will lessen or end disability or lost wage pay from the insurance company. Again, it’s a good idea to check with your lawyer or the insurance company if you are unsure if your care will be covered.
What Are Unnecessary Medical Treatments?
On the flip side, some medical treatments will be deemed unnecessary, and this means the insurance company won’t cover their expense. You can still move forward with the treatment if you’d like, but it will come out of your pocket. Most people don’t want to pay out of pocket for medical expenses, so they avoid treatments that will be deemed unnecessary. Here’s a look at some treatments that the insurance company may rule unreasonable or unnecessary:
- Treatments not recommended by your treating physician
- Experimental treatments
- Acupuncture or massage therapy
- Treatment for issues not related to your work injury
- Overtreatment of minor injuries
- Duplicate care provided by different doctors
- Treatments that continue after patient has been deemed at maximum medical improvement
Neither of these lists have all the reasonable or unreasonable treatment options, so maybe your treatment fell into a gray area and was denied by insurance. If you need help contesting a treatment that insurance has deemed unnecessary, reach out to Hey Workers today. We can help you challenge the case and win you the care options you deserve. For more information, give us a call at (844) 439-9675.
