To Network Or Not To Network (Is there any question?)


 In 2005, the 79th Texas Legislature passed House Bill (HB) 7, which authorized the use of workers’ compensation health care networks certified by the Texas Department of Insurance (TDI). The TDI has recently come out with report cards comparing network claims with non-network claims.

Findings:When overall medical costs are looked at for the first six months of a claim, non-network claims averaged $2,217.00 and network claims ranged from $2,221.00 to $3,530.00 depending upon the network. The report does not seem to include the additional administrative expenses incurred to run the networks. Only one network was able to have a lower average of lost time from work (Alliance with 14 weeks). Non-network claimant’s missed an average of 19 weeks. While the other networks claimants averaged from 19 to 31 weeks of lost time. Not surprisingly injured workers’ had greater satisfaction with their treating doctor when in non-network care, with 48% satisfaction. While injured workers treated within networks were satisfied with their treating doctor from 46% down to 36% of the time. Non-network providers also got their patients to a higher level of physical function level than any of the networks achieved.

Conclusion: Networks have taken away injured workers ability to control their own treatment. What good has come from providing the insurance companies more control over the medical treatment: Costs are higher; satisfaction is lower; physical function is lower; and they are not getting claimants back to work any sooner. The more we take away our citizens freedoms, the more we lose. Not only do we limit qualified professionals from competing; we open the door for backroom deals to be made, hurting not only the injured worker, but the employers.

If you have any questions call our Dallas office at (214)357-1782.


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