Some treatment costs higher for worker's comp claims

Sorboni Banerjee reports

- The cost of a CT scan has a local tech for a music and entertainment company stunned.

“That's bull; that really is. It’s unjustifiable! I'm sorry it's wrong! I figured just a medical bill, it would be maybe a thousand, and sure enough, it’s $17,862,” says Roger Demaris.

He slipped while moving equipment. Brandon Regional treated the injury, and did the CT scan as a precaution since it was a head injury. Because he was hurt on the job, Demaris took the hospital bill to his boss at Coldman Music.

“He was freaking out. When I first saw it, I thought it was a joke too, maybe a typo, error,” Demaris says.

But it's no error. When you file a bill under Workers Comp, versus private insurance, the price can skyrocket.

Attorney and healthcare consultant Bryan Rotella explains, “They send that bill along and workers comp insurers pay 40-percent more than the average health insurance company.”

Brandon Regional acknowledged the difference in prices, stating:

"What patients pay has more to do with the type of insurance coverage one has, than their charges. Insurance plans, including worker's compensation plans, negotiate payments with hospitals."

Industry-wide, prices aren't based on the actual services, but the relative bargaining power of the insurance providers. Only government plans - Medicare and Medicaid - are not negotiated.

“If a $17,000 bill comes in, typically Medicare pays 80-percent of what that private insurance would pay,” Rotella breaks it down.

Florida is one of the few states that requires price transparency in healthcare under a new law signed into effect by governor Rick Scott, so consumers can compare costs online. But in case like Demaris's, he had rushed to the ER.

“Folks go to healthcare scared and afraid to ask about what things cost and ask if they can get it less expensive elsewhere,” Rotella says.

Healthcarebluebook.com and fairhealthconsumer.org are resources to check. The non-profits use databases of medical and dental services to run free websites to help consumers estimate and plan costs.

We checked "CT scan without contrast" like Demaris received. The fair price, according to those sites, is around $300 dollars.   

Hospitals will always be more expensive than off site imaging centers.

Brandon Regional stated:

“Hospital pricing takes into account the need to be prepared to deliver the most advanced care around the clock, compared to other care points that have less regulatory requirements and provide services during a much shorter time frame.”

Demaris's employer's workers comp will cover the big bill for his injury, but his employer’s deductible will likely go up just like with home or auto insurance, or worse could drop them completely.

“I can't justify $17,862” Demaris said, shaking his head.

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