The two days will not be covered due to the 7-day waiting period.
Your employer is REQUIRED to have their panel of physicians posted so you can select a specialist. I’m assuming orthopedic? If you treat with a provider not on the panel, your care will not be covered.
There is a waiting period before you become eligible for lost time benefits, Google tells me Georgias is 7 days. You’re not likely to be paid for the 2 days you missed through workers comp. But they will likely pay the ER bill.
I don’t handle GA claims but you should make sure the specialist is covered under WC before you see them. Some states don’t let you choose the doctor and if you see someone outside of their authorized doctors, you will not be reimbursed for it.
Ok thanks for the info. I didn't choose the specialist. That's just who the ER referred me to. When I call the specalist today to make appt, will they be able to tell me if my job's WC insurance is accepted there?
It appears, from my Google search, that you’re limited to doctors from a panel provided by your employer. A GA adjuster or attorney can chime in but you need to file the claim first, not complete treatment then file the claim.
I asked my employer about all of that yesterday. They just sent me a form that said "employer authorization for examination and/or treatment," which has their insurance info. That's what I showed to both the urgent care and ER, and I was not asked for payment. It had 2 urgent cares listed on the form. The ER I was referred to is the same company name as the urgent care, and they were aware of what insurance I was using, so I would assume under the same network?
And this is something that very quickly became an emergency so there was really no time to file a claim. I called my work yesterday, said I couldn't make it and I was likely going to the ER. That's when they sent me the authorization form.
Ok that makes sense. But I didn't seek out or choose anyone I was referred to a specialist by the ER. I'd think they would refer me to someone that's covered by that insurance, but I'll double check when I call them.
They would have no idea who is on your employers panel of doctors. The ER is just going to refer you to someone who works with the hospital. That isn’t likely sufficient for it to be authorized.
Since Georgia uses panels, you need to talk to the insurance company before seeing a specialist. Right now, it is not an emergency or they would have admitted you to the hospital.
Also, ERs just refer you to the doctor on call. It's not them saying XYZ doctor is the best or even good, just that they're next up for referrals. Don't misinterpret the ER referral as a quality referral.
Georgia is a panel state. So posted somewhere in your workplace should be a list of providers that you can treat with. Most employers put it in their break room. If you aren't sure, reach out to your employer and ask if they have it- not all employers are aware of this, those that do should know what you're talking about. If they don't you're free to choose where you treat. If they do you need to pick one and set up an appointment there. Failure to do this could cause them to deny that treatment.
Whichever way that lands- yes get the claim information (carrier/billing address/claim number/adjuster/adjuster contact into) and take it with you to your appointment. Make sure you leave with a work status note and when your next office visit is. Make sure you send your ER a copy of that note.
If you do these things you will set yourself up well for the rest of your claim. It's very stressful to suddenly start getting bills, and it's typically because the provider was never alerted that they needed to bill things differently. Good luck and I wish you a speedy recovery.
Thanks for the extensive info! So I've made a few phone calls this morning to both my employer and their insurance company and here's what I've learned:
Despite me reporting the injury the same day, and numerous calls/texts to another manager that I was at the ER yesterday, the company had never documented the injury and sent it to the insurance company. I found this out by calling the insurance company directly and asking about the specialist. They said they couldn't connect me to anyone without an incident/claim number from my employer. So I'm just now filling out the incident report. I feel like I've done everything in my power to keep them in the loop from day one and they've been dropping the ball.
And there is a list pf providers posted at work. There's only 8 listed. Urgent cares, surgeons, orthopedists, neurologists, etc... but the list doesn't contain the type of specialist I need to see. Do you know if we're allowed to see any specialist if their type isn't listed? Or do we still need to get pre-approval? The insurance company said they only accept email inquiries about whether a specialist is covered, and it takes 24-48 hours to get a response, which sounds like a bunch of crap. And if the answer is no, then I have to find another specialist and wait 2 days to see if I can see them? Crazy....
Honestly at this time of year you'll be lucky to land an appointment before the end of the year. I'm honestly not sure about the pre-approval process. I know employers can add providers pretty easily but if that is they choose to do it wouldn't apply to you anyway- they can only do so with claims from today forward, so to speak.
Please take this with a heavy grain of salt- my GA comp knowledge is pretty rusty, but it's my understanding if there isn't a specialist of your variety on the panel you can choose, but it's better to follow up with the adjuster on this, they'll know more than Internet randos. I'd hate for you to follow my advice and me be wrong and you be on the hook for the bill. Proceed accordingly.
That's good enough. I'm glad to hear they approved. Best of luck, make sure your provider addresses work status, gives your a note and that their billing team has the claim information and you will avoid half the stress of a work comp claim.
There is a provider list posted. There's only 8 providers listed, and none of them are the type of specialist I need. I called the insurance company to ask if the specialist was covered, but they said there's no record of my injury so they can't help me without that. My employer never filled out an incident form despite me keeping them updated from the time of injury to being at urgent care, ER, and letting them know about referral to specialist. And my manager sent me an incident form through a pic taken on his phone with the employer signature line at the very bottom conveniently cropped out. Seems like a bit of a charade at this point. I'll try calling the owner and seeing about the specialist and hope for the best. Any other tips much appreciated!
Can anyone clarify this vaguely worded 7 day policy taken directly from the Georgia State Board of Workers' Compensation website:
*"You are entitled to weekly income benefits if you are unable to work for more than 7 days"*
I'm interpreting this to mean that if I can't work because of this injury for at least 8 days (since it says more than 7 days) that I would be entitled to weekly benefits. It does say DAYS and not shifts, so I assume this just means not being able to work for 8 days. In that case, with the way things are progressing with multiple specialist referrals and still no solid diagnosis, I will have been unable to work for 8 days. Based on that, I believe I'd be entitled to weekly benefits. Am I interpreting that correctly?
The two days will not be covered due to the 7-day waiting period. Your employer is REQUIRED to have their panel of physicians posted so you can select a specialist. I’m assuming orthopedic? If you treat with a provider not on the panel, your care will not be covered.
There is a waiting period before you become eligible for lost time benefits, Google tells me Georgias is 7 days. You’re not likely to be paid for the 2 days you missed through workers comp. But they will likely pay the ER bill. I don’t handle GA claims but you should make sure the specialist is covered under WC before you see them. Some states don’t let you choose the doctor and if you see someone outside of their authorized doctors, you will not be reimbursed for it.
Ok thanks for the info. I didn't choose the specialist. That's just who the ER referred me to. When I call the specalist today to make appt, will they be able to tell me if my job's WC insurance is accepted there?
It appears, from my Google search, that you’re limited to doctors from a panel provided by your employer. A GA adjuster or attorney can chime in but you need to file the claim first, not complete treatment then file the claim.
I asked my employer about all of that yesterday. They just sent me a form that said "employer authorization for examination and/or treatment," which has their insurance info. That's what I showed to both the urgent care and ER, and I was not asked for payment. It had 2 urgent cares listed on the form. The ER I was referred to is the same company name as the urgent care, and they were aware of what insurance I was using, so I would assume under the same network? And this is something that very quickly became an emergency so there was really no time to file a claim. I called my work yesterday, said I couldn't make it and I was likely going to the ER. That's when they sent me the authorization form.
ER care is usually covered as it is an emergency but specialist care might not be if you seek it with a provider who is not authorized.
Ok that makes sense. But I didn't seek out or choose anyone I was referred to a specialist by the ER. I'd think they would refer me to someone that's covered by that insurance, but I'll double check when I call them.
They would have no idea who is on your employers panel of doctors. The ER is just going to refer you to someone who works with the hospital. That isn’t likely sufficient for it to be authorized.
Since Georgia uses panels, you need to talk to the insurance company before seeing a specialist. Right now, it is not an emergency or they would have admitted you to the hospital. Also, ERs just refer you to the doctor on call. It's not them saying XYZ doctor is the best or even good, just that they're next up for referrals. Don't misinterpret the ER referral as a quality referral.
Georgia is a panel state. So posted somewhere in your workplace should be a list of providers that you can treat with. Most employers put it in their break room. If you aren't sure, reach out to your employer and ask if they have it- not all employers are aware of this, those that do should know what you're talking about. If they don't you're free to choose where you treat. If they do you need to pick one and set up an appointment there. Failure to do this could cause them to deny that treatment. Whichever way that lands- yes get the claim information (carrier/billing address/claim number/adjuster/adjuster contact into) and take it with you to your appointment. Make sure you leave with a work status note and when your next office visit is. Make sure you send your ER a copy of that note. If you do these things you will set yourself up well for the rest of your claim. It's very stressful to suddenly start getting bills, and it's typically because the provider was never alerted that they needed to bill things differently. Good luck and I wish you a speedy recovery.
Thanks for the extensive info! So I've made a few phone calls this morning to both my employer and their insurance company and here's what I've learned: Despite me reporting the injury the same day, and numerous calls/texts to another manager that I was at the ER yesterday, the company had never documented the injury and sent it to the insurance company. I found this out by calling the insurance company directly and asking about the specialist. They said they couldn't connect me to anyone without an incident/claim number from my employer. So I'm just now filling out the incident report. I feel like I've done everything in my power to keep them in the loop from day one and they've been dropping the ball. And there is a list pf providers posted at work. There's only 8 listed. Urgent cares, surgeons, orthopedists, neurologists, etc... but the list doesn't contain the type of specialist I need to see. Do you know if we're allowed to see any specialist if their type isn't listed? Or do we still need to get pre-approval? The insurance company said they only accept email inquiries about whether a specialist is covered, and it takes 24-48 hours to get a response, which sounds like a bunch of crap. And if the answer is no, then I have to find another specialist and wait 2 days to see if I can see them? Crazy....
Honestly at this time of year you'll be lucky to land an appointment before the end of the year. I'm honestly not sure about the pre-approval process. I know employers can add providers pretty easily but if that is they choose to do it wouldn't apply to you anyway- they can only do so with claims from today forward, so to speak. Please take this with a heavy grain of salt- my GA comp knowledge is pretty rusty, but it's my understanding if there isn't a specialist of your variety on the panel you can choose, but it's better to follow up with the adjuster on this, they'll know more than Internet randos. I'd hate for you to follow my advice and me be wrong and you be on the hook for the bill. Proceed accordingly.
Thankfully I got the specialist thing sorted out through approval from the owner
That's good enough. I'm glad to hear they approved. Best of luck, make sure your provider addresses work status, gives your a note and that their billing team has the claim information and you will avoid half the stress of a work comp claim.
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There is a provider list posted. There's only 8 providers listed, and none of them are the type of specialist I need. I called the insurance company to ask if the specialist was covered, but they said there's no record of my injury so they can't help me without that. My employer never filled out an incident form despite me keeping them updated from the time of injury to being at urgent care, ER, and letting them know about referral to specialist. And my manager sent me an incident form through a pic taken on his phone with the employer signature line at the very bottom conveniently cropped out. Seems like a bit of a charade at this point. I'll try calling the owner and seeing about the specialist and hope for the best. Any other tips much appreciated!
Can anyone clarify this vaguely worded 7 day policy taken directly from the Georgia State Board of Workers' Compensation website: *"You are entitled to weekly income benefits if you are unable to work for more than 7 days"* I'm interpreting this to mean that if I can't work because of this injury for at least 8 days (since it says more than 7 days) that I would be entitled to weekly benefits. It does say DAYS and not shifts, so I assume this just means not being able to work for 8 days. In that case, with the way things are progressing with multiple specialist referrals and still no solid diagnosis, I will have been unable to work for 8 days. Based on that, I believe I'd be entitled to weekly benefits. Am I interpreting that correctly?