Health Care Provider Survey


Michigan.gov Home	DELEG \| Sitemap \| Contact \| Online Services \| Agencies

The following survey is being conducted to assess the demographics of the current provider population treating Michigan's injured workers. Your input and suggestions will assist the Health Care Services Division in determining if changes need to occur to assist you in your care of Michigan's injured worker population.

Bold = required fields

1. Do you currently treat Michigan workers' compensation patients?

	Yes
	No (What reason or reasons influence your decision not to treat. Check all that apply)
		Required documentation and reports
		Disputes
		Billing and payments
		Other: Please specify

2. What services do you provide?

	Occupational Medicine Clinic
		Free-standing
		Hospital owned
	Facility Services
		Hospital
		Ambulatory Surgery Center
		Skilled Nursing Home
		Other: Please specify
	Family Practice
	Chiropractic
	Surgery
		General Surgeon
		Hand Surgery
		Neurosurgeon
		Orthopedic Surgeon
		Ophthalmology
		Thoracic Surgeon
	Physical Medicine and Rehabilitation
	Mental Health
	Ophthalmologist/Optometrist
	Pain Specialist/Anesthesiologist
	Other
		Ambulance
		Dental
		DME
		Orthotics/Prosthetics
		Podiatry
		Hearing/Speech
		Home Health
		Pharmacy

3. What percentage of your services are provided for workers' compensation?

	Less than 10%
	10-20%
	20-30%
	30-50%
	50-70%
	70-100%

4. What is your geographic location?

Greater Detroit Area

Grand Rapids, Muskegon & Kalamazoo

Tri-County Area (Flint, Midland, Saginaw & Bay City)

Lansing -Jackson

Southwestern Lower Michigan

Upper Lower Michigan

Upper Peninsula

5. How satisfied are you with the process set forth in the Health Care Services Rules when treating Michigan's injured workers?

	Always satisfied
	Usually satisfied
	Satisfied
	Somewhat dissatisfied
	Always dissatisfied

6. If you are not satisfied with the process, what obstacles or problems does your office encounter?

	Employer does not report the claim to the workers' compensation carrier.
	Carrier does not determine compensability of the claim in a timely manner.
	Carrier will not authorize treatment.
	Carrier requests duplicate information (claims and medical documentation).
	Incorrect payments-unresolved reconsiderations
	Late payments
	Mediation process
	Other: Please specify

7. Comparing reimbursements received from workers' compensation to those of other payer sources, would you say that payments received for treating Michigan's injured workers generally:

	Frequently exceeds other reimbursements
	Usually exceeds
	Equals
	Sometimes is less than other reimbursements
	Always less than other reimbursements?

8. What suggestions do you have for changing the process?

9. What is your hourly charge for depositions for workers' compensation cases?

10. Do you have any suggestions for education programs or materials for workers' compensation?

11. Would you like your email address included in our electronic distribution list for sending out rule change notices? If so, please provide your email address below.

	Yes
	No

FIRST NAME:		LAST NAME:
ORGANIZATION:
ADDRESS:
CITY, STATE, ZIP:
TELEPHONE NO.:
E-MAIL ADDRESS:

Submitting this form may take between 8 to 10 seconds
Please be patient.