There has been much discussion about healthcare reform under the new administration and how it has the potential to affect the workers’ compensation industry. The healthcare industry has been a source of contention and debate among insurance companies as well as the general public in recent years, and insurance carriers administering workers’ compensation claims must ensure they indemnify their claimants while simultaneously controlling claims costs and staying ahead of healthcare reform revisions. While no healthcare reform has been finalized as of yet, there are several ways the workers’ compensation industry may be affected by proposed changes.
Previously the possibility of enforcing minimum benefit thresholds at the state level for workers’ compensation claimants was strong, according to Insurance Thought Leadership. With the current administration, there is speculation regarding the likelihood of less federal government involvement in benefit standards. Conversely, due to the need to protect the Social Security program and its rapidly dwindling funds, it is possible that some injury costs may be shifted from the Social Security disability program to workers’ compensation insurance.
Furthermore, a handful of states have recently introduced new legislation involving changes to their workers’ compensation programs. Insurance Thought Leadership goes on to report that some of these potential revisions could include reducing fee schedules on prescription drugs or medical services and expanding some qualification thresholds to include mental health damages.
Healthcare reform at the federal level has already had a tremendous impact on health insurance and further revisions or a complete repeal of the current Affordable Care Act could further restrict health insurance access and affordability for the general public. If these proposed revisions are signed into law, many more people will not seek the appropriate health care or preventative care they require, thus resulting in the potential for increased injuries during the work day. Additional injuries lead to additional claims and higher costs to insurance carriers in the workers’ compensation industry.
All of these potential issues could combine to result in dramatically higher costs to insurance companies administering workers’ compensation claims. By proactively partnering with a third-party administrator (TPA) before any healthcare reform changes are ratified, insurance carriers will be able to help reduce their cost burden.
As a trusted TPA with over 20 years of experience, Northwood brings several solutions to the table. Northwood offers its clients access to a credentialed network of home health care providers with high quality care and reduced rates. Furthermore, Northwood implements a pre-authorization process for all claims involving prescription drugs or home health care services as a way to ensure all prescribed services are injury related. This saves both time and money for the insurance carrier yet also increases claimant satisfaction by expediting the claims process and ensuring claimants have zero out-of-pocket claims expenses. For more information about partnering with Northwood, please contact a representative to discuss workers’ compensation claims in more detail.
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