With the continuous development of free-standing licensed emergency rooms, Fund members may want to know if these facilities are on the approved doctor list for the Fund. Through its partnership with the Alliance, The Fund offers a treating doctor list for injured employees, which does not include emergency rooms.
At the free-standing emergency rooms, visits are treated as true emergencies rather than minor emergencies, and they are billed accordingly. A recent analysis from Mitchell International revealed that emergency room services have showed a dramatic increase of 52.7 percent from 2006-2015, compared to only a 9.1 percent increase for medical services commonly used in workers’ compensation claims.
As opposed to urgent care or “minor emergency” facilities, free-standing emergency rooms typically bill at a higher level than the injury or illness warrants because they maintain licensing as a hospital-based emergency room. Emergency room licensing brings with it a number of requirements which increase costs when compared to urgent care centers. However, in the event of a cardiac-related or serious emergency, it is recommended that employees go to a hospital-based emergency room.
As with other medical trends, the Fund continues to monitor free-standing emergency rooms and their billing practices to help control costs for members. The Fund has partnered with the Alliance since 2007 to ensure injured employees receive appropriate medical care and manage skyrocketing medical costs. The Alliance has consistently attained top scores compared to Networks on the annual Texas Department of Insurance Network Report Cards. Find out more about the Fund's participation in the Alliance and other benefits of the Workers' Compensation program.