§ 28-33-8 - Employee's choice of physician, dentist, or hospital – Payment of charges – Physician reporting schedule.
SECTION 28-33-8
§ 28-33-8 Employee's choice of physician,dentist, or hospital – Payment of charges – Physician reportingschedule. – (a) An injured employee shall have freedom of choice to obtain health care,diagnosis, and treatment from any qualified health care provider initially. Theinitial health care provider of record may, without prior approval, refer theinjured employee to any qualified specialist for independent consultation orassessment, or specified treatment. If the insurer or self-insured employer hasa preferred provider network approved and kept on record by the medicaladvisory board, any change by the employee from the initial health careprovider of record shall only be to a health care provider listed in theapproved preferred provider network. If the employee seeks to change to ahealth care provider not in the approved preferred provider network, theemployee must obtain the approval of the insurer or self-insured employer.Nothing contained in this section shall prevent the treatment, care, orrehabilitation of an employee by more than one physician, dentist, or hospital.The employee's first visit to any facility providing emergency care or to aphysician or medical facility under contract with or agreement with theemployer or insurer to provide priority care shall not constitute theemployee's initial choice to obtain health care, diagnosis or treatment.
(2) In addition to the treatment of qualified health careproviders, the employee shall have the freedom to obtain a rehabilitationevaluation by a rehabilitation counselor certified by the director pursuant to§ 28-33-41 in cases where the employee has received compensation for aperiod of more than three (3) months, and the employer shall pay the reasonablefees incurred by the rehabilitation counselor for the initial assessment.
(b) Within three (3) days of an initial visit following aninjury, the health care provider shall provide to the insurer or self-insuredemployer, and the employee and his or her attorney a notification ofcompensable injury form to be approved by the administrator of the medicaladvisory board. Within three (3) days of the injured employee's release ordischarge, return to work, and/or recovery from an injury covered by chapters29 – 38 of this title, the health care provider shall provide a notice ofrelease to the insurer or self-insured employer and the employee and his or herattorney on a form approved by the division. A twenty dollar ($20.00) fee maybe charged by the health care provider to the insurer or self-insured employerfor the notification of compensable injury forms or notice of release forms orfor affidavits filed pursuant to subsection (c) of this section, but only iffiled in a timely manner. No claim for care or treatment by a physician,dentist, or hospital chosen by an employee shall be valid and enforceable asagainst his or her employer, the employer's insurer, or the employee, unlessthe physician, dentist, or hospital gives written notice of the employee'schoice to the employer/insurance carrier within fifteen (15) days after thebeginning of the services or treatment. The health care provider shall inwriting present to the employer or insurance carrier a final itemized bill forall unpaid services or treatment within three (3) months after the conclusionof the treatment. The employee shall not be personally liable to pay anyphysician, dentist, or hospital bills in cases where the physician, dentist, orhospital has forfeited the right to be paid by the employer or insurancecarrier because of noncompliance with this section.
(c) Every six (6) weeks, until maximum medical improvement,any qualified physician or other health care professional providing medicalcare or treatment to any person for an injury covered by chapters 29 – 38of this title shall file an itemized bill and an affidavit with the insurer,the employee and his or her attorney, and the medical advisory board. A tenpercent (10%) discount may be taken on the itemized bill affidavits not filedin a timely manner and received by the insurer one week or more late. Theaffidavit shall be on a form designed and provided by the administrator of themedical advisory board and shall state:
(i) The nature of the injury being treated;
(ii) The type of medical treatment provided to date,including type and frequency of treatment(s);
(iii) Anticipated further treatment including type,frequency, and duration of treatment(s), whether or not maximum medicalimprovement has been reached or when it is expected to be reached, and theanticipated date of discharge;
(iv) Whether the employee can return to the former positionof employment or is capable of other work, specifying work restrictions andwork capabilities and the degree of functional impairment and/or disability ofthe employee;
(v) Any ownership interest in any ancillary facility to whichthe patient has been referred for treatment of a compensable injury.
(2) The affidavit shall be admissible as an exhibit of theworkers' compensation court with or without the appearance of the affiant.
(d) "Itemized bill", as referred to in this section, means astatement of charges, on a form HCFA 1500 or other form suitable to theinsurer, which includes, but is not limited to, an enumeration of specifictypes of care provided, facilities or equipment used, services rendered, andappliances or medicines prescribed, for purposes of identifying the treatmentgiven the employee with respect to his or her injury.
(e) The treating physician shall furnish to the employee, orto his or her legal representative, a copy of his or her medical report withinten (10) days of the examination date.
(2) The treating physician shall notify the employer, and theemployee and his or her attorney immediately when an employee is able to returnto full or modified work.
(3) There shall be no charge for a health record when thathealth record is necessary to support any appeal or claim under the Workers'Compensation Act § 23-17-19.1(16).
(f) Compensation for medical expenses and other servicesunder § 28-33-5, 28-33-7 or 28-33-8 is due and payable within twenty-one(21) days from the date a request is made for payment of these expenses by theprovider of the medical services. In the event payment is not made withintwenty-one (21) days from the date a request is made for payment, the providerof medical services may add, and the insurer or self-insurer shall pay,interest at the per annum rate as provided in § 9-21-10 on the amount due.The employee or the medical provider may file a petition with the administratorof the workers' compensation court which petition shall follow the procedure asauthorized in chapter 35 of this title.
(2) The twenty-one (21) day period in subdivision (1) of thissubsection shall begin on the date the insurer receives a request withappropriate documentation required to determine whether the claim iscompensable and the payment requested is due.