Medical Provider Information
Q: What bills must get paid?
A: Vermont law requires workers comp insurers to pay for medical treatment that is medically reasonable and causally related to the work accident. In order for the treatment to be reasonable the following conditions must be met:
- The treatment must be appropriate in terms of type, amount, frequency, level, setting and duration to the injured person’s diagnosis or condition;
- Consistent with generally accepted practice parameters as recognized by health care providers in the same or similar general specialty;
- The treatment must help restore or maintain the patient’s health, prevent deterioration or palliate the patient’s condition
Q: When must the insurer pay?
A: The insurance company has 30 days from receipt of the bill to either (1) pay the bill; or (2) provide the providers and patient written notice why it is refusing to pay the bill. If the insurer does not provide written notice within 30 days the Department of Labor is obligated to issue an order for payment. Either the provider or the worker may request the order.
Getting Pre-Authorization For Treatment
As a result of recent changes in Vermont law a health care provider may get pre-authorization for treatment. If the health care provider submits a pre-authorization request, the insurer has 14 days to respond in writing. If the insurance company fails to respond the Commissioner of Labor shall issue an Order approving the treatment plan.