Can a physician charge in excess of the medical Florida Fee Schedule?

The answer is yes in certain circumstances.  We were recently involved in a case involving a physician who took over the care of an injured worker when the injured worker’s long standing treating physician retired.  As most physician now require, the new physician wanted to charge an initial fee in excess of the fee schedule and subsequent fees in excess of the fee schedule otherwise he would not agree to take over the care.  Sounds familiar? The claimant was under an obligation to pay a portion of the medical bills due to a previous stipulation with the Employer/Serving Agent with regards to subrogation as a result of a third party settlement.  The claimant refused to see the physician.  The Judge of Compensation Claims ruled that the physician was not authorized because there was no valid agreement to charge in excess of the fee schedule. How do you enter into a valid agreement to allow the physician to charge in excess of the fee schedule?  Section 440.13(14)(b) of the Florida Statutes allows charges in excess of the Florida medical fee schedule as long as it is in writing and as long as the agreement identifies “procedures aimed at providing quality medical care to injured workers at reasonable costs.”  In other words, there must be a written agreement between the physician and the Employer/Servicing Agent wherein the parties agree that a fee in excess of the medical Florida fee schedule will be paid because the physician 1) agrees to timely schedule of appointments for injured workers; 2) agrees to participate in a return to work program; 3) agrees to expedite reporting of treatment provided to injured workers; 4) agrees to perform quality assurance; or 5) agrees to a precertification program on all procedures.  To be valid, the language most be specific. So next time, you have no choice but to authorize a physician who will not accept the fee schedule, make sure you get an agreement in writing delineating the above.   Jonathan Cleare v. Menzies Aviation, Inc./Gallagher Bassett Services, Inc. February 13, 2015 Case No. 1D14-1924. 

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