The average medical costs paid per claim are higher in the network for back and shoulder injuries compared to claims outside the network, but lower for all other injuries, according to a study released Tuesday by the National Council on Compensation Insurance.
Boca Raton, Florida-based NCCI evaluated the effect of medical provider networks on work compensation costs for 10 common work injuries. At present, medical provider networks account for about 80% of workers who compensate for medical payments, and networks often set prices at amounts discounted under government fee schemes for physicians. services were paid to network providers; receivables with less than 40% paid in the network were considered claims outside the network.
The rating agency found that although the average paid medical costs were higher in the network for expensive lumbar and rotator cuff tear injuries, claims in the network were cheaper than claims outside the network for the other injuries, including ankle, foot / hand / wrist, knee injuries and neck pain injuries. Network claims also tended to cost less for outpatient hospital care and resulted in fewer hospital admissions.
For network claims, the average total cost of both permanent partial and temporary total disability claims tended for all ten types of injuries. to be lower or about the same as claims handled outside the network, according to the study. The total costs for receivables in the network were 4% lower for PPD and 5% lower for TTD compared to the network claims.
Claims in the network, however, were more likely to receive awards for permanent damage than outside the network. claims. NCCI speculated that this could be due to more serious injuries being referred directly to the drug supplier's network. Catalog