Injured workers are allowed to attend private hospital emergency department

workcover-ed

Something very few injured workers are aware of is that they are allowed to attend a private hospital emergency department, if/when they believe they are in need of urgent medical attention.

Injured workers are allowed to attend private hospital emergency department

Injured workers are entitled to be compensated for the reasonable cost of medical and like services incurred as a result of a work-related injury or illness.

WorkSafe Vic (and any other workcover authority, and their agents) state they will only pay the reasonable cost of medical and like services approved under the Act for a work related injury or illness, where the service meets the following criteria:

  • treatment is for a work related injury or illness
  • the provider is currently registered with WorkSafe to deliver the service being provided
  • the service is necessary and appropriate
  • the cost of the service is reasonable
  • the service is specifically provided for in the Act or approved by WorkSafe under the Act.

This includes attending a private hospital Emergency Department

What many injured workers don’t know is that, just as they can have their treatments (i.e. surgery etc) undertaken at a private hospital, they can also attend a private hospital emergency department when in need of urgent medical attention.

The injured worker’s medical practitioners and healthcare professionals are primarily responsible for identifying the required medical and like services required.

The injured worker can choose which medical practitioner or healthcare professional they visit, and which private hospital or private hospital emergency department they visit.

In some states, such as NSW, injured workers have to attend a “nominated primary care doctor (GP)”, however they are still free to choose for example their rehabilitation service provider, as well as the private hospital – including a private emergency department.

How best to go about attending a private ED

WorkSafe Vic (and other workcover authorities) can pay the reasonable costs of private hospital services required as a result of a work-related injury or illness.

Written approval is required from the agent prior to the provision of the service, UNLESS the request relate to emergency psychiatric inpatient treatment, or general emergency department services.

If a hospital seeks prior approval, this must not be delayed by the workcover insurer.

A private hospital is a private hospital:

  •  within the meaning of the Health Services Act 1988 or s178 of the Health Act 1958
  •  within the meaning of a law of another State or of a Territory or
  •  outside Australia if approved by WorkSafe Vic / Workcover Authority

A private hospital service means the provision by a private hospital of:

  •  maintenance, attendance and treatment
  •  nursing care and treatment
  •  medicines, medical, surgical and other curative materials, appliances or apparatus
  •  any other usual or necessary services provided by a hospital with respect to the treatment of the injury or illness of a worker.

If your emergency situation can wait an hour or two, we highly recommend you either call or send an urgent email to your case manager, explaining your intention/need/referral to attend an emergency department. You simply request an urgent note (email is fine) to be written to the ED you will be attending, which states that your workcover insurer will pay for the ED visit/treatment/images.

In doing so, it will make your life a lot easier when you present to the private ED (for example the ED of a private hospital where you have been treated previously in relation to your work injury), because the written approval note will automatically “satisfy” the private ED billing requirements of the private hospital’s ED, so that you, the injured worker, do not have to pay upfront for your ED admission/treatment/images (which costs on average at least $400 just to see the ED doctor), and then wait forever to be reimbursed (God forbid your case manager may want to seek “justification” again for attending emergency treatment/images etc).

Obviously if your condition cannot wait an hour or two, simply go straight to the emergency department and don’t bother asking your case manager for a pre-approval note.

There is indeed a huge difference in the way you are treated in a public emergency department, compared to a reputable private hospital’s ED, whether you need acute, severe pain management, imaging (x-rays, CT, MRI etc) or a specialist’s opinion (i.e. orthopedic surgeon).

 

[Post dictated by WCV and manually transcribed on behalf of Workcovervictim]

 



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    Xchangingvictim October 19, 2013 at 8:28 am

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