House Co-Sponsorship Memoranda

In the near future, I plan to introduce the attached legislation to ensure that medical providers within the workers’ compensation system are paid for their services in a timely and fair manner. This legislation reflects constructive ideas that were proposed to me by medical providers (in particular by members of the PA Orthopedic Society). In general, the PA workers’ compensation system is performing well with respect to treatment of injured workers, as is reflected in the 2011 Medical Access Study done by the Bureau of Workers Compensation which showed 87% of injured workers were satisfied with their care. It is important to note that this same report noted that timeliness of payment to medical providers had improved, but the report still noted that 23% of providers surveyed felt timeliness of payment was a problem. In addition, the report noted that 9% of providers felt that having their fees “discounted” even though they were not participating in a PPO network was a major problem. In my opinion, it reasonable to expect employers/insurers to pay undisputed medical bills in the 30 day timeframe already required by the law, and it is reasonable to assume that providers should not have their bills “discounted” without a written contract with a PPO/Employer/Insurer.

In order to enact changes to the law to ensure that providers are treated fairly within the workers compensation system, my legislation proposes the following reasonable reforms:

• Prohibits discounting of provider fees unless there is a written contract with an employer/insurer/agent of the insurer. Often, “downstream” providers (who have no contract with PPO or other third party administrators) are reimbursed at rates lower than they originally billed, even though there was no contract agreeing to do so.