Charge for FMLA medical certification

Crash

One of our employees was told there was a $25 charge by her doctor for completing an FMLA certification form. Have any of you had similar reports, and how did you handle the situation?

Down_the_Middle

This is becoming more popular with MD's as another revenue source. We do not reimburse the employee for this expense if it's an initial certification. If we require 2nd and 3rd opinions, then we pay for this cost, as required by FMLA. I would strongly discourage you from agreeing to pay any "surcharge" to MD's for the initial certification info. It's the employees responsibility to obtain this info and is a matter between the physician and the patient about the so-called addt'l fee.

Gar

I totally agree with Down-the-Middle. Don't let your employer fall victim to this apparent grab for money. This was an issue in a recent grievance we had. We didn't pay for the initial certification and the employee screamed foul. However, if we require it, we will pay for a 2nd or 3rd opinion.

bsa

Our PPO only pays "contracted amounts" for physician services. If the doctor tries to bill the patient for amounts over the contracted amount, the PPO wants to know about it. If the doctor is billing for "professional" services, that's between him and the patient. As a patient, I would find another doctor. As the company requesting medical certification -- we would pay for 2nd and 3rd opinions, nothing else.

The DOL Form WH-380 states that it should take an average of 10 minutes to complete their certification form. They also ask for comments and suggestions about the form -- Administrator, Wage and Hour Division, Department of Labor, Room S-3502, 200 Constitution Avenue NW, Washington, D.C. 20210

dhnyct

We have a staff of about 70 employees, and to date we have had only a few FMLA cases. It's disturbing that some doctors have started charging for completion of the certification form, especially since I doubt it requires that much time.

Since the employee is already facing a difficult situation, as well as a period with no pay, we cover this expense. Besides, I've found the best way to get the certificate timely is to have the employee sign the authorization section and send off for the documentation myself.

Never thought about a CPT code that would allow the insurance to pick up the charge......

Rockie

I also would find another doctor if mine started charging for this service. They are already getting paid for the medical service they are rendering to the patient and that should be sufficient for the minimal amount of time it takes for them to sign (or in most cases rubber stamp) the form.