At a Glance

Workers’ Comp Treatment Prices Exceed Group Health

Workers’ Compensation and Group Health Median Prices Paid, Common Knee Arthroscopy, 2009

A New Benchmark WC FS No Caption

Prices for common surgeries paid for by workers’ compensation payers can run two-to-four times greater than the price paid by group health insurers, according to Workers Compensation Research Institute data.

Workers’ comp prices paid for office visits, in contrast, are typically within 30 percent of the cost borne by group health insurance. WCRI reached these conclusions in a 2013 study titled “A New Benchmark for Workers’ Compensation Fee Schedules: Prices Paid by Commercial Insurers?”

The study looked at median non-hospital prices paid for five common surgeries and four common office visits across 22 states. The chart above relies on data for knee arthroscopy surgeries performed in 2009 to provide an example of the gap in prices paid by group health and workers’ comp across the states.

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