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TXANS Association of Responsible Nonsubscribers

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Austin, TX 78701
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Estimates indicate that as many as 115,000 businesses operate as nonsubscribers to workers' compensation and the majority of their employees receive workplace injury benefits from an employer-funded occupational injury benefit program. Physicians that strive to increase their nonsubscriber business may recognize similarities in the healthcare needs of subscriber and nonsubscriber programs but they must also understand the differences.

In most cases nonsubscriber programs are governed by the terms of a nonsubscriber injury benefit plan that outlines, among other things, the provision of benefits and the associated rights and responsibilities of both the employer and the employee. The plan may also designate the providers authorized to provide care as well as the terms and conditions of the provider relationship.

Many nonsubscriber plans are supported by insurance policies that are not unlike many health insurance plans in that some pay directly to the health care provider while others provide reimbursement to the employer. Reimbursement scenarios may be more attractive to healthcare providers since it may simplify the associated paperwork and shorten the time between care and payment.

Nonsubscribers may also utilize different methods for funding their nonsubscriber programs, which could also affect the provider's method of payment. Smaller nonsubscribers are more likely to have a fully insured program while larger employers tend to utilize high-deductible programs. Despite the method of funding most employers and/or employer representatives (insurance carriers, third-party administrators, etc.) require their approved to providers to execute an agreement regarding payment schedules. In many cases, the fee schedules outlined in such nonsubscriber agreements mirror or closely resemble the workers' compensation fee schedules. But unlike subscribing employers, nonsubscribing employers have the flexibility to tailor their agreements to meet the needs of both their nonsubscriber program and the healthcare providers they select. For example, when the TWCC Medical Fee Guidelines were implemented in 2003, many nonsubscribing employers chose not to reduce fees but rather continue to pay 1996 rates. Nonsubscribers understand the value of a quality healthcare provider that shares the interest of good care and a quick return to work.

Nonsubscribers should not be confused with "self-insured" employers. Self-insured businesses have certification from the State to fund their workers' compensation program (rather than utilizing a workers' compensation insurance policy) but the program is governed by workers' compensation. Typically these are extremely large employers and currently there are only about 50 self-insured employers in Texas.

Nonsubscribing employers have a good reason to ensure employees receive quality health care: tort exposure. Nonsubscribing employers know that unhappy employees and employees that aren't working are more likely to pursue tort claims than those that are satisfied with their care and their ability to return to the workplace. Therefore nonsubscribing employers strive to not only provide safe workplaces that prevent injury but also sound benefits and quality care.

Nonsubscribing employers work closely with healthcare providers to offer creative return-to-work programs that accommodate the needs of injured workers. Unlike workers' compensation where price controls and regulation are viewed as the primary methods for controlling medical costs, nonsubscribers believe that costs can be managed by maintaining cooperative relationships with providers to offer quality care and useful return-to-work initiatives.

Nonsubscription is an option that is available to most Texas businesses but is more prominent in industries with the highest rates and costs. These industries include but are not limited to restaurants, grocery and convenience stores, hospitals, hotels, retail establishments, manufacturing facilities, transportation providers and many service sector businesses. Those industries that may not have the option to nonsubscribe include: governmental entities, construction companies, high tech industries and chemical and oil producers.

In addition to seeking out nonsubscribing employers, providers should also consider alliances with third-party claim professionals that specialize in nonsubscription. TXANS' website offers a Supplier Directory, which contains information regarding claims professionals that target nonsubscribers.

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