Your Injured Worker (IW) has a co-morbidity; such as diabetes, asthma, hypertension, psychiatric disorder, etc. It is impacting his/her recovery from a work-related injury. You are informed he/she does not have private healthcare insurance and can no longer see their private physician, what resources are available for the IW to find care?
Controlling the case and obtaining a successful outcome may be delayed until you can get this factor under control.
The employee should first be directed to contact the employer (if employed) for clarification about their benefits.
Note: The Obama Health Plan will not be covering pre-existing conditions until 2014.
Where can you find a medical resource for them? Be aware that certain eligibility requirements are mandated by these programs.
- COBRA- coverage.
- Local County Health/Hospital System where the IW lives.
- Ask treating MD if they know of any resources to refer IW (WC or “X” Private MD).
- Refer them to such agencies as: National Diabetes Association or American Heart Association.
- Direct them to go online to the following website: HealthCare.gov.
HealthCare.gov provides the IW with information about their specific state plans for those without insurance. The website provides instructions for obtaining information about these plans.
Usually there are three options per state:
- The Pre-Existing Condition Insurance Plan (PCIP) is a new program offered in every state under the Affordable Care Act. The PCIP may be able to help if you’ve been locked out of the insurance market while the nation transitions to 2014.
- Medicaid.
- Finding Care You Can Afford – provides state specific website to find affordable healthcare.
- Texas has 4th option: Texas High Risk Plan.
Author: Deborah Goza, MS, RN, CCM, COHNS
Editor: D. Perry