I was called by a prospective client about her BWC claim and the fact that she could not get authorized for treatment. After talking to her for a few minutes it became obvious that I needed to speak with her doctor. So, I call the doctor and ask about the treatment that he requested on the C9 authorization form. I was dumbfounded by his comments during the conversation! Here is the skinny on our discussion.
First I ask him what he filled out on the form. He told me that he asked for permission to provide therapy modalities over a multi week period. It was apparent to me, during the conversation with the prospective client and the doctor, that the claim was medically inactive. The request should have asked for claim reactivation.
If you are an injured worker, you must be informed and know that if you have an allowed BWC claim and you do not obtain medical treatment for a period of 14 months, your claim becomes inactive. Once that happens, you may have to prove – all over again – that your needed treatment is related to the original work injury. The doctor’s mistake was not requesting reactivation of the claim.
But now for the clincher to the conversation . . . . Then I ask the doctor when he sent the C9 Form to the MCO (Medical Care Organization). His reply, on the 5th (today is the 13th). I ask if he has a fax transmittal sheet to prove that he sent it on the 5th and that the MCO received the C9 on the 5th. He seemed surprised by the question. Well, if he was surprised by the question, I was dumbfounded that a medical provider – an OhioBWC Certified Medical Provider at that – would not be aware of the simple rules governing the time limits pertaining to authorization of treatment requested via the C9 Form.
I explain that there are rules and that the rules are printed right on the form. A state funded employer’s MCO has 3 days to respond to a C9. If there is no response, guess what – the requested treatment is authorized. For a self insured employer, there is a 10 day response time. I can’t tell y0u how many times MCO’s blow the response time. A C9 Form is attached to this article via hyperlink below so you can see it for yourselves.
In this instance, the doctor could not prove that he sent the C9 form to the MCO over 7 days before, without response.
Who suffers? The injured worker because here she is waiting for necessary treatment that could have started days before.
I then explained to the doctor that there is a rule regarding the submission of medical bills. A medical bill must be submitted to the MCO or OhioBWC within 2 years of the date of service. If the bill isn’t filed within the 2 year period, the BWC doesn’t have to pay the bill, even if the treatment was rendered for allowed claim conditions, because the bill is time barred. Who suffers in such situation? Both the doctor and the injured worker. But then I suppose the doctor eventually would sue the injured worker for payment of the bill even though the doctor failed to file his bill in a timely fashion.
Bottom Line – The Importance of a Fax Transmittal Sheet – I explained that the doctor needed to set his fax machine to spit out a transmittal sheet so he can prove when and to whom he sent the C9 for treatment approval and also to prove when and to whom he submitted his medical bills for payment.
Hopefully, the doctor learned what needs to be done.
Please check with your doctor to make sure that he/she can prove when documents, office notes, C9 authorization requests, and bills were filed with the BWC.
If you have any questions about your Ohio Workers’ Compensation claim, please give us a call. We would like to help you receive all of the benefits to which you are entitled.
To make sure your claim is being handled correctly, call Mike Gruhin Board Certified Ohio Workers’ Compensation Specialist at 216-861-5555. Get the protection you need and all of the compensation benefits and money you deserve.