Is My Medical Care Transferable To Another State?
If you have been approved for workers compensation benefits in Nevada and decide to move to another state during your treatment, your medical care may be transferable to another health care provider if certain requirements are met. Not only must your new physician either be on an approved provider list with another state or agree to the Nevada fee schedule, your new physician must send in the appropriate paperwork regarding progress reports and pre-authorization for medical services. The out-of-state doctor must provide the same information as provided on the State of Nevada workers compensation documents in order for medical care to be transferable and approved by the adjuster.
How to request an out-of-state medical provider
If you move to a different state while you are receiving medical treatment under your workers compensation benefits, you may be able to continue to receive paid insurance coverage through a new physician in your new home area.
Request out-of-state care from your adjuster
Before moving, you should first discuss the issue with your adjuster to be sure that your medical care may be transferable.
Find a new doctor
You should ask your adjuster if there is an out-of-state provider list for the area where you will be moving. This can help you to choose a new physician closer to your new home. If there is no such a list available, you will need to find a doctor in your new area that is willing to accept the payments provided by the Nevada fee schedule for workers compensation insurance claims. This may take some time and effort in speaking with different physicians until you find someone who is willing to work with you in this matter.
Formally request approval for out-of-state care in writing
After you have spoken with your adjuster and selected a new physician, you need to send in a request in writing in order for your medical care to be transferable. According to Nevada administrative codes regarding workers compensation, prior authorization must be approved before you can begin to see your new physician under your insurance claim benefits in NAC 616C.176.
Challenges with getting out-of-state care approved
There are many challenges that will need to be overcome in changing to a physician in a different area. These challenges may result in a lot of additional work on your part and some extra time, but with proper preparation you should be able to continue with medical treatments.
Doctor agreeing to Nevada fee schedule
If there is no approved provider list for your new area, one of the greatest challenges you may face is finding a new physician that will accept the approved payment rates on the fee schedule for transferable medical care in your new home state. Once you find a doctor, there are additional challenges you may face to continue to receive workers compensation benefits.
Getting the appropriate reports and forms
Your new doctor will still have to file the appropriate progress reports, documentation, and pre-authorization requests as your original doctor. In order for your adjuster to continue to receive the essential information from your new doctor, it is often easiest to copy the Nevada forms and leave them with your new physician after every appointment. In this manner, the appropriate information will always be provided so that you can continue to receive medical benefits.
Making sure treatment or physical therapy is uninterrupted
It is important that your new doctor is aware that many services and anything more than 6 physical therapy appointments require prior authorization from your adjuster. Your new physician will need to send in the appropriate request forms in a timely manner so that your medical treatments are not interrupted while waiting for this authorization. As long as you are willing to keep up with working with your new physician for completing and sending in all of the necessary documentation, you should have no problem with transferable and uninterrupted medical care.
Adjuster not having out-of-state provider list
A new approved provider list makes matters easier with continuity of care being able to run more smoothly. However, if you do the legwork and find a new physician who is willing to accept the payments provided on the fee schedule and to work with you regarding all of the documents and prior authorization requests, you should have little problem with continuity of care.
What to do once your adjuster approves the out-of-state medical provider
After visits with your new doctor, you should obtain copies of the progress report for your adjuster. Your new physician may have workers compensation forms for your new home state, but these forms should only be used if they provide the same information as Nevada forms. It is often best to make copies of the blank forms and leave them with your new physician to make things easier. Make sure that your new doctor is sending the forms to your adjuster in Nevada rather than to the adjusters they typically deal with in your new state of residence.
How to avoid insurance denial for major out-of-state care
The best way to prevent any denial in service coverage is to send in the appropriate requests for prior authorization of services as soon as possible. Your new physician has to request pre-authorization for many procedures, including any surgeries and any physical therapy treatment that will go beyond 6 visits. Be sure that authorization is approved before having any surgical procedures and additional physical therapy appointments. Remember that it often takes a little more time for documentation to be received from out-of-state sources, creating a longer wait time for approval or denial of services.
Permanent Impairment Rating
If your new physician feels that you need a permanent impairment rating upon being released from medical care, you will need to return to an approved doctor in Nevada who provides such ratings. While this may be a somewhat costly and time-consuming experience, it is necessary to continue to receive benefits. In addition, the insurance provider covers reasonable travel expenses in order to return to receive the necessary rating.Go to the Next Article