Managing an Injured Worker’s Medical Care

Managed care

Utilization review

Zurich's PPO network

Medical bill review

    Managed Care – care-full management

    Zurich's managed care programs are about more than just reduced medical bills – they are about helping to ensure that your injured employees receive high-quality care and getting them back to work as soon as medically possible. Our programs are also concerned with increasing efficiencies to provide better service, easier administration and greater cost savings for you.

    Zurich's toll-free Care Center takes claims calls 24 hours a day, 365 days a year. Nurses in the center help expedite or address medical care issues – and answer more than 90 percent of all calls within 20 seconds! This efficient service continues with our bill review service, which, by paying only at fee schedule, usual and customary levels and through specialty networks, offers substantial savings to our policyholders.

    As a further service, Zurich processes medical bills within 14 days from receipt to payment, reducing the potential for confusion or rebilling.

    Utilization review – a personal approach

    Zurich's URAC-accredited utilization review programs meet the industry's highest standards. But we've set a few or our own as well. So while the industry standard for completing UR decisions in three days, Zurich reviewed more than 90 percent of its cases in just two. And while some UR companies simply send letters indicating that requested care does not meet criteria, Zurich requires physician-to-physician peer discussions on all noncertified requests – which helps all parties reach resolutions sooner.

    Zurich's PPO network – quality care

    Directing injured workers into our network means they'll interact with medical professionals who understand work-related injuries. While many insurance companies tout PPO penetration in the middle to high 50s, Zurich is in the 70-percent range – with pharmacy just shy of 90 percent! This helps control pharmaceutical costs and makes it easier for injured workers to get prescriptions.

    Medical bill review

    Our skilled reviewers evaluate all medical and hospital bills for appropriateness and over utilization. The system checks against state-specific fee schedules, reviews bills for PPO negotiated rates, identifies questionable charges and finds hidden double payments caused by complex billing practices. This process is fully integrated with our utilization review process.

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