$15,000 Medical-Only Program

//$15,000 Medical-Only Program
$15,000 Medical-Only Program 2017-03-09T08:30:21-07:00

Once an employer enrolls in the 15K Program, the employer is responsible for the bills in all medical-only claims with injury dates after the enrollment effective date unless:

  • The employer notifies BWC within 14 days of being notified that a claim has been filed, that it does not wish to pay for the bills in that claim;
  • The employer notifies BWC that the $15,000 maximum has been reached in a claim;
  • The employer notifies BWC of the last date of service it will be responsible for in a particular claim. This could be the date of injury or after payment of any amount up to $15,000.

Once the employer notifies BWC to remove a claim from the 15K program the managed care organization (MCO) will begin processing the bills in that claim.

Employers participating in the program must do the following:

  • Notify their injured workers and their health-care providers that the employer, not the MCO, is paying the medical bills for an injury;
  • Pay all bills within 30 days of receipt;
  • Notify BWC and the MCO if/when the $15,000 maximum is reached and supply proof of such payment to the MCO;
  • Keep a record* of all work-related injuries including;Injured worker’s name, address and
  • Social Security number;
  • Date and time of injury;
  • Type of injury;
  • Part of the body injured;
  • A brief description of the accident or occurrence;
  • Copies of all bills with proof and date of payment under this program.
  • Proof of payments made within 30 days of request from BWC.
  • Documentation for excluding any wages paid to the employee while off work in the $15,000 limit.
  • Documentation showing no denial of any bills. If you participate in the program, you inherently approve the first $15,000 of medical costs.

*These records must be maintained for six years from the last date of bill payment.

Reaching the $15,000 Maximum

If the payment of a particular bill will exceed the $15,000 maximum, the employer should pay that portion of the bill that brings the total paid to $15,000 and then inform the provider to bill the MCO for the balance. The employer should then notify BWC and the MCO that the $15,000 maximum has been paid. Copies of all bills with proof and the dates of payment should be sent to the MCO. It then becomes the MCO’s responsibility to process all future bills. BWC will not reimburse the employer.

Lost-time claims

If the injured worker loses more than seven days of work, the injury is no longer eligible for this program and a claim must be filed with BWC. If a claim has already been filed with BWC, the process to change the claim to lost time will automatically remove the claim from the 15K Program. The MCO will be responsible for processing subsequent medical bills. BWC does not reimburse the employer for bills paid under this program prior to the change over from medical only to lost time.

Injured worker and employer rights

  • Payment of medical bills under this program in no way supercedes the right of the injured worker to file a workers’ compensation claim.
  • Payment of medical bills under this program does not waive BWC’s right to hear and decide a claim if filed.
  • Payment of medical bills under this program does not waive the employer’s right to contest a claim if filed.

Opting out of the program

Employers can opt out of the 15K Program by calling 1-800-OHIOBWC and listen to the options. Once the employer notifies BWC of the desire to opt out of the program, BWC will send written confirmation of this decision. The MCO will then be responsible for processing bills for all medical-only claims with injury dates on or after the program termination date.