Comp pays more than group health on similar medical services

Workers compensation insurers pay more for medical services than that of group health to treat comparable injuries, according to a research report released Friday by the National Council on Compensation Insurance.

In examining the workers comp experiences from NCCI’s medical data call, which captures transaction‐level detail — service, charges, payments, procedure codes and diagnosis codes — on medical bills processed on or after July 1, 2010, for 35 states, researchers found that costs for chronic injuries in comp are 235% higher and 160% higher for acute injuries.

Specifically, acute “traumas to arms and legs consistently have smaller cost and utilization differences in WC, while chronic pain-related injuries, such as bursitis and back pain,” have larger differences, according to the report.

Also, a more expensive mix of procedures in complex workers compensation cases contributes to higher costs relative to group health, especially for referral-based care, such as radiology and surgery, according to the report.

For the acute injuries, quantity of services accounts for nearly 90% of the entire cost differential between workers comp and group health and for chronic injuries, differences in quantity account for four‐fifths of higher comp costs, according to the report.

This article was first published in Business Insurance.

Leave a Reply