Out of State Workers Comp Health Benefit Issues

[dawnsroy]

My husband is on Texas worker comp and has lifetime medical. We are currently in Arkansas and is in immediate need of a orthopedic surgeon. His primary Dr is in Houston and we are unable to get him there currently. I'm trying to find a doctor in Arkansas or even in Memphis (closest major town near where we are) that will accept tx workers comp. Please help. His leg is very bad and I am worried. The emergency room doctors here all have referred him to an orthopedic specialist but I can't find one that accepts Texas workers comp. Thanks in advance.

[tony]

dawnsroy

His primary Dr is in Houston and we are unable to get him there currently.

We are currently in Arkansas and is in immediate need of a orthopedic surgeon

The emergency room doctors here all have referred him to an orthopedic specialist

What orthopedic specialist did they refer him to?

Something's missing here - did you inform those ER doctors that this is a worker comp case and that he is under the care of a doctor in Texas?
I know for a fact doctors have emergency pagers for other doctors to contact them if needed.
ER docs don't make referrals then send a patient shopping, especially in an emergency - this doesn't make sense.

Those ER doctors would never go around his treating physician - they would provide emergency care if needed and refer him to his treating physician for follow up.
Only his treating physician can refer him to a specialist, you can't change doctors without first submitting a request and getting an approval.

Also, even if you did find an orthopedic doctor to see him, he would need pre-authorization.
You can't just pick up - go to another state and seek medical care without consulting your doctor or the carrier, that's not how things work.
You guys better high tale it back home, you're in trouble.

Doctor Choice in the Texas Workers' Compensation System
If an injured worker wants to change treating doctors, he or she must submit a written request to the TWCC explaining why the change of treating doctor is needed. 4 The TWCC then reviews the request and issues an order either approving or denying the injured worker's change of doctor request. If needed, either the injured worker or the insurance carrier can dispute the TWCC's decision by requesting a Benefit Review Conference (BRC).
http://www.tdi.texas.gov/pubs/wcreg/3-2.html

Tony

[complwyr]

If he does not have a lawyer on the Texas case, then call the adjuster and see if you can get something worked out. They may have a doc in Ark or Tenn that they already have a relationship with that will see your husband. But otherwise, I agree with Tony. Good chance he will have to go back to Texass for treatment.