Surgery Rates for Workers' Comp Vary Widely Across States

According to a study conducted by the Workers Compensation Research Institute (WCRI), hospital rates for outpatient surgery paid by workers’ compensation tend to vary greatly between states, with costs generally being lower in states that have fixed fee schedules for injured workers. Likewise, workers comp costs for injured worker surgery also tend to vary considerably from Medicare rates for common procedures.

The study, which examined 33 states representing 87 percent of workers’ comp benefits in the country in 2014, revealed that outpatient payments for surgeries fluctuated greatly between states, ranging from 69 percent below the study-state median in New York to a staggering 142 percent above the median in Alabama. The differences in average workers’ comp payments and Medicare rates across states was even more significant, reaching as low as 27 percent below Medicare in New York and a whopping 430 percent above Medicare in Louisiana.

The study’s major conclusions include:

  • States with no workers’ comp fee schedules had overall increased outpatient payments in comparison to states with fixed schedules.
  • States with percent-of-charge systems had markedly higher hospital payments than those with fixed-amount fee schedules.
  • States with fixed-amount fee schedules and those with cost-to-charge systems had lower payments among study states.

In addition to showing the major differences between costs among states, this study serves as a reminder of the complexities of the workers’ compensation system and the importance that injured workers retain the services of a knowledgeable attorney to ensure they receive the benefits they deserve. If you have been injured at work or have fallen ill in connection with the duties of your occupation, the Cobb County workers’ compensation lawyers at Chestnut & Beller can help. From filing the necessary paperwork to appealing claim denials, we have the vast legal expertise and knowledge to help you navigate through the workers’ compensation process with ease.

Call (770) 285-5542 or send us an email today to get started towards retaining the advocacy you need.