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If we need to order extra testing for example; echo, sleep
studies, extra blood work, does that get billed to their  personal
insurance?
Do we hold the certification as suggested or give them a temp fail until
testing is finished, requiring a repeat office visit  and or another charge?

FMCSA doesn’t address payment for either the commercial driver (DOT) exam, nor any subsequent testing required.  Some motor carriers pay for the exam and not any other testing, some don’t pay for anything, and everything in between.

As a medical examiner, you certainly have every expectation of getting paid for the services you perform.  However, you have to make it clear what you are providing when you quote a client or a driver a fee for your exam.  Most examiners I know include the history, physical examination, required vision and whisper hearing tests, and the dipstick urinalysis for one overall “DOT exam” fee.

A frequently needed test is the audiogram in either a hearing booth or with a hand-held audiometric device.  This is generally an extra charge and needs to be authorized by the paying party before performing the test.

Any other testing, whether it is pulmonary function testing, ECG, urine cultures, blood work, sleep studies or other diagnostic testing, in my experience, is usually the responsibility of the driver.   Some of these are available in our office and we will offer it to the driver if they wish, but they are always free to go to their personal physician to obtain any additional required testing.

The decision on whether to fail the driver or give them a temporary certification is usually up to the examiners discretion, but many conditions have certain guidelines that should either be followed, or have documentation in the comments section as to why the guidelines are being deviated from.

For example, there is the MRB-MCSAC recommendations on either failing or giving a 60 day temporary certification to a driver suspected of having sleep apnea needing a sleep study, depending on crash risk and other factors.  Or many of the guidelines that proscribe certain waiting periods after a medical event or procedure.  The latter can all be found in the Medical Examiners Handbook.

When sending the driver out for testing or specialty consult, we use a form that states specifically what we need, and I will often include a reference for the specialist to the appropriate section of the medical examiners handbook so they have a clear understanding of the issues we need resolved as commercial driver examiners.

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