§ 27-14-401 — Medical, hospital and ambulance expenses; review of claim; employer and division designated providers; contracts for bill review, case management and related programs; air ambulance reimbursement

Wyoming § 27-14-401

• Jurisdiction: Wyoming
• Title 27: Labor and Employment
• Ch. 14: WORKER'S COMPENSATION
• Art. 4: EMPLOYEE BENEFITS

Text

(a) The expense of medical and hospital care of an injured
employee shall be paid from the date of the compensable injury
unless under general arrangement the employee is entitled to
free medical and hospital care or the employer furnishes
adequate and proper medical and hospital care to his employees.
(b) No fee for medical or hospital care under this section
shall be allowed by the division without first reviewing the fee
for appropriateness and reasonableness in accordance with its
adopted fee schedules.
(c) Hospital care includes private nursing or nursing home
care if approved by the director.
(d) Medical and hospital care shall be obtained if
possible within Wyoming, or in an adjoining state if the
hospital or health care provider in the adjoining state is
closer to the scene of the accident or to the usual place of
employment of the employee than a hospital or health care
provider in Wyoming, unless otherwise authorized by the
division. Except as otherwise authorized by the division,
reimbursements for travel in obtaining medical and hospital care
shall not be paid:
(i) For travel of less than ten (10) miles one (1)
way except by ambulance travel as set forth in W.S.
27-14-401(e);
(ii) For travel other than that necessary to obtain
the closest available medical or hospital care needed by the
employee except in those instances where travel within Wyoming
is at a greater distance than travel outside of Wyoming;
(iii) In excess of the rates at which state employees
are paid per diem and mileage.
(e) If transportation by ambulance is necessary, the
division shall allow a reasonable charge for the ambulance
service at a rate not in excess of the rate schedule established
by the director under the procedure set forth for payment of
medical and hospital care, provided this subsection shall not
apply to air ambulance transport services.
(f) Subject to subsection (h) of this section, an employer
or the division may designate health care providers to provide
nonemergency medical attention to his employees or to claimants
under this act. Except as provided in subsection (h) of this
section, the employee may for any reason, select any other
health care provider. If the employee selects a health care
provider other than the one (1) selected by the employer or the
division, the employer or division may require a second opinion
from a health care provider of their choice. The second opinion
may include an independent medical evaluation, a functional
capacity exam or a review of the diagnosis, prognosis, treatment
and fees of the employee's health care provider. The
independent medical evaluation, a functional capacity exam or
the review by the employer's health care provider shall be paid
for by the employer and the evaluation, a functional capacity
exam or review by the division's health care provider shall be
paid from the worker's compensation account.
(g) The division may engage in and contract for medical
bill review programs, medical case management programs and
utilization review programs. The division may also negotiate
with out-of-state health care providers regarding the payment of
fees for necessary medical care to injured workers, not to
exceed the usual, customary charges for the comparable treatment
in the community where rendered or the amount payable for the
same services by the worker's compensation fund or account of
the state where rendered, whichever is less.
(h) In the case of an inmate employed in a correctional
industries program authorized by W.S. 25-13-101 through
25-13-107 or performing services pursuant to W.S. 7-16-202, the
department of corrections shall select the health care provider
for the inmate.
(j) Emergency and medically necessary air ambulance
transport services for an employee shall be covered under W.S.
42-4-123, subject to availability and any limitations specified
by the department under W.S. 42-4-123(a). The department of
workforce services shall pay reimbursement for services under
this section to the department of health as specified under W.S.