Episode 26 Federal Workers Compensation Coffee Break Podcast - Emergency Medical Care, Ca-16 & Optum PBM

Federal Workers Compensation Coffee Break

Federal Workers Compensation Coffee Break Podcast is about all things related to Federal Workers Compensation, FECA, OWCP, DOL & Longshore claim filing as an injured federal worker. The podcast is an educational and informative training on how to navigate the DOL -OWCP claims filing process for all types of injured US government and federal workers. The podcaster has 27 years in assisting with federal workers compensation as a consultant and trainer. The podcast is free and is educational. If you need help with anything related to a federal workers compensation claim...help is just a cup of coffee away.
Form CA-16, Authorization for Examination and/or Treatment. Form CA-16 is the vehicle by which the employing agency authorizes initial examination and/or medical treatment at OWCP expense. It is used to refer an employee who sustains a traumatic injury to a local physician or hospital of the employee's choice. CA-16s are issued by Employing Agencies to Injured Workers so they can seek immediate medical care. When there is a CA-16, NO authorization is needed for office visits and consultations, labs, hospital services (including inpatient), X-rays (including MRI and CT scan), physical therapy, and Emergency services (including surgery) related to the work injury.

a. Emergency Medical Facility. Emergency medical care by private physicians, clinics or hospitals may be authorized if such care is warranted. The employee may seek continuing medical care from the physician who provided the initial treatment or select another local physician.
(2) Effect of Adjudication. Once a case is accepted, the period of authorization is automatically extended to cover necessary services for the accepted condition, and additional authorization is not necessary unless requested by a provider in a specific case.
The U.S. Department of Labor (DOL) has contracted with Optum Workers’ Compensation Services (“Optum”) to provide Pharmacy Benefit Management (PBM) services to the Federal Employees’ Compensation Act (FECA) Program. Optum will be responsible for pharmaceutical transactions including but not limited to implementation of FECA Program eligibility determinations and pricing for pharmaceutical drugs provided to FECA claimants. FECA claimants MUST use the Optum/FECA pharmacy benefit card for injury-related prescriptions. No other pharmacy benefit card will be recognized for a claimant’s federal workers’ compensation injury. In a new Injury Ca-16 without an Optum pharmacy card the injured worker will need to pay for their medications with their personal insurance while a new case is being adjudicated.
Dr. Taylor's educational podcast utilizes his experience and history as a DOL - OWCP provider and his years of consulting and teaching all things federal workers compensation related. This is an educational short form format for learning how to successfully file federal workers compensation claims. So grab a cup of coffee and lets begin.
Dr. Taylor's contact information for more information or assistance is:
https://[e-mail]
If you need a provider or assistance with a DOL claim in Tampa, Jacksonville or other areas of Florida you can make an appointment to see him and the other providers at his clinic at 813-877-6900.