Workers’ comp fee schedules are complex, convoluted, and subject to update—but they are not subjective. Do the arithmetic correctly, and the proper reimbursement amount is a provable fact.

The daisyWizard Fee Schedule Calculator doesn’t care if the claims administrator wants a lower reimbursement or the doctor wants a higher reimbursement. It is as accurate as it is transparent—a fact that a representative for Farmers Insurance apparently fails to grasp.

In a text message to a provider’s representative, the Farmers representative spuriously (and potentially libelously) claimed that one can “manipulate” the daisyWizard’s calculations “however you want.”

Let’s be crystal clear: our reimbursement calculations are not a matter of controversy or debate. No magic button allows providers to conjure favorable reimbursements. The daisyWizard’s arithmetic and strict adherence to fee schedules—unlike the specious whinging of this ill-informed insurer representative—hold up under scrutiny.

The Farmers representative’s message (below) exemplifies one of the many, many reasons providers increasingly refuse to treat California’s injured workers.

Farmers' Representative’s Nonsensical Bargaining

In the exchange below, the provider’s representative attempted to obtain payment from Farmers for treating an injured worker. The Farmers representative asked for the provider’s medical reports and questioned the balance due.

The provider’s representative helpfully offered to confirm the amount due by “do[ing] a quick daisy Bill” rather than wasting Farmers’ time or money on a separate bill review service. The Farmers representative balked at this suggestion, claiming not to “trust” daisyBill.

Additionally, the Farmers representative laughably claimed that “it’s unusual” for providers to insist on payment at the full rates dictated by California’s Official Medical Fee Schedule (OMFS).

Seriously?

This text demonstrates how claims administrators have contorted California workers’ compensation into a nonsensical haggling system by forcing providers to expend resources to obtain (or not) payment. This provider:

• Treated a Farmers’ injured worker
• Hired and paid a representative to obtain proper reimbursement
• Had to navigate Farmers’ refusal to agree on the amount owed per the fee schedule
• Had to argue over whether it’s “unusual” to be paid at fee schedule rates

Treating California’s injured workers should not require providers to haggle, beg, barter, or otherwise engage in unwarranted steps simply to be paid at the state-established rates.

Farmers' Absurd Fee Schedule Assertions

The Farmers representative’s claims that the daisyWizard is manipulable are patently ridiculous. For any given service date, the daisyWizard always displays the exact amount due per the applicable fee schedule, along with every detail that went into the calculations.

Further, the Farmers’ position makes about as much sense as refusing to pay the tab at a restaurant because you don’t “trust” the cash register—while simultaneously claiming that it’s “unusual” for diners to pay the amounts listed on the menu.

Fortunately, the daisyWizard always has the receipts, as in the example below.

This provider is irrefutably entitled to “demand the full value of the billlong” according to the Physician Fee Schedule. As demonstrated in the recent articles below, claims administrators (not daisyBill) routinely fail to determine the correct reimbursement amounts:

• Santa Monica & Lien on Me Improperly Reimburse MDs
• Sedgwick Stiffs Doctors With Outdated Fee Schedule Rates
• CorVel Corrects Reimbursement Errors

Calculating correct reimbursement amounts based on the applicable fee schedules is difficult, so providers and payers rely on tools like the daisyWizard to do the heavy lifting.

For an insurer’s representative to dismiss objective calculations in favor of haggling is an invitation to chaos, and another very understandable reason for providers to avoid treating injured workers. “Trust” is not a factor in arithmetic.

Correction: A previous version of this article referred to the Farmers representative as an “attorney” rather than a representative.

Know (and get) exactly what you’re owed for treating injured workers. Try the daisyWizard’s Fee Schedule Calculator today.

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