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OhioBWC - Basics:  Payment of medical bills

Medical payments

Prescriptions

  • After your claim is allowed, give your prescription with your claim number to any BWC-certified pharmacy. They will bill BWC's Pharmacy Benefits Manager (PBM) directly, and you will have no deductible or co-pay on allowed medications in your claim.
  • A pharmacy can fill a 10-day supply of your first prescription before the claim is allowed or has a BWC claim number. The pharmacy should use your Social Security number, date of injury and write "for work-related injury" on the script.
  • If you have paid for a prescription and need to be reimbursed, you have two options.
    1. After your claim is allowed, ask your pharmacist to resubmit the prescription to BWC's PBM. The PBM will pay the pharmacy the allowed amount for the prescription, and the pharmacy will reimburse you.
    2. File a Request for Injured Worker Outpatient Medication Reimbursement (C-17). Attach prescription labels with pricing information and mail to OptumRx, P.O. Box 968066, Schaumburg, IL 60196-8066.

Medical bills
Give your claim number to all of your medical providers who treat you for the allowed conditions in your claim. You should receive a BWC ID card that lists your claim number and managed care organization (MCO) contact information. The medical provider will request authorization for all medical treatment from the MCO assigned to your claim and listed on your ID card.

Surgery and diagnostic tests
Your treating medical doctor, or physician of record, will submit a Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) to the assigned MCO for pre-authorization of surgeries or diagnostic tests for the allowed conditions in the claim.

Medical bills for additional conditions
Sometimes the treating medical doctor will need BWC to add an additional condition to the claim before the MCO can authorize additional treatment. The medical bill for the treatment for the additional condition cannot be paid until the additional condition is allowed in the claim.



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