January Blog

The $15,000 Medical Only Program

The Best Way to Save Time and Money on BWC Medical Claims

The $15,000 Medical Only Program


We are always looking for ways to save our clients money through aggressive claims management and group discount programs because as a Third Party Administrator (TPA), that is literally our job. But we take it a step further to ensure our clients are getting the very best service and taking advantage of all the cost-cutting opportunities available to them.

One of our favorite programs, and probably the most underutilized, is the Bureau of Workers' Compensation's $15,000 Medical Only Program. In our opinion this program is one of the best kept secrets for saving money on your company's medical only claims.  Far too many companies are missing out on the opportunity to control costs and future BWC premiums which is why this program is so very important.

Think about it this way: Roughly every $500 the BWC pays out on medical claims ends up costing an employer an additional $2500 in future premiums until that claim drops off (4 years is how long a claim impacts an employer).  This program would allow an employer to pay a $500 bill today and therefore eliminate the $2500 in added premium costs down the road.

CSI Vice President Tony Canovi says, “It has helped our clients reduce their future costs by paying some of these small to medium-sized medical only claims in lieu of the Bureau.  This allows them to keep their group rating discount, stay in the {maximum possible discount in a group program} 53%, and ultimately provides them with more cost control.”

Business Development Manager Brett Pizzuto says Compensation Solutions, Inc. has taken this program a step further.

“Not only informing our clients that this program exists, but that we can administer it for them too. We'll take care of all of it for you. We'll even send you cards to give to the injured workers if you are aware there is a claim. And the injured worker can take that to the health care provider with instructions on what to do.”

Any business can enroll in this program, but many employers have never heard of it before.

Pizzuto says the proof of the program is in the savings. “We've been able to save some of our clients tens of thousands of dollars per occurrence.  More often than not when meeting with a new client we realize that had they been in this program leading up to this point they would have saved a good amount of money.  And in some cases this amount was tens of thousands of dollars. But no one's ever told them about it.

So that's something we really started focusing on, and offering that as one of our premium solutions. And it's been huge for the majority of our clients who are in it.”

But how does the program save an employer money?

If a company decides to pay a bill instead of having the BWC pay, it will pay the “street rate.” Health care providers will not give that business a discount. That employer will pay thousands of dollars. But if the same company was enrolled in the $15,000 Medical Only Program, it would pay the same rates the BWC pays, which is at a substantial savings. The company could pay just a few hundred dollars versus a few thousand dollars.

What if a company doesn't normally have a lot of claims? Is the program still worth it?

Pizzuto says it's still a great idea. “Nobody has a crystal ball to know who is going to get injured doing what. So it's really in place more as a safety net or an insurance policy. It's just in case.”

Why is it called the $15,000 Medical Only Program? Does a company have to pay $15,000 to be in the program?

Pizzuto hears this question a lot. “The $15,000 name tends to scare employers. It doesn't mean you are required to pay $15,000. It means the bureau will allow employers to pay up to $15,000 per claim should the claim ever reach that level. But why I love the program is because it allows employers to opt out at any point on a per claim basis. So you’re not bound to make these payments if cash flow is tight.”

So what's the catch?

There's no real downside to the program, but there are requirements.

A participating employer must set aside a block of money so when there is a claim, CSI can quickly pay the medical provider. Employers are required to pay the bureau in a timely manner or risk being removed from the program.

A company can opt in and out of the program whenever it wants. But it must be enrolled in the program to get the cost savings.

If you are interested in signing up for the program or hearing more details about how this would benefit your company, please contact our office at 614-799-8439 or email Brett Pizzuto, bpizzuto@compensation-solutions.com