Treatment with a Doctor Outside the Health System

The Previant Law Firm

What problems may I encounter if I work with a doctor outside of my health system?

If you are injured at work, treat with your own physician, one that you select, not your employer. A question that may arise, however, is whether to treat with a doctor who is within your health system (HMO, PPO, etc.), or a doctor/specialist who is highly recommended but who is outside of your health system.

There is certainly nothing initially wrong with going to a doctor outside of your health system, but you should be aware of some problems that may arise later.

If the workers’ compensation carrier is paying for your injury and time off, the workers’ compensation carrier will probably want to have you see its doctor. At that time, there is certainly the chance that its doctor will declare that you have reached a healing point. This opinion may be at odds with the doctor/specialist who is outside your health plan. The workers’ compensation carrier will rely on its doctor’s opinion and stop payment of your doctor’s medical bill. This will obviously create immediate problems. The doctor/specialist will probably not continue to treat you because he or she is not getting paid. You will then have to find a doctor within your own health system. There is always the risk that this doctor may not agree with the doctor/specialist with whom you were treating outside of your health system.

Therefore, it is probably the better practice to stay within your own health system for treatment. If the workers’ compensation carrier stops payment of your benefits, at least you are within the health system that has agreed to cover your medical costs.