Employers Turning to Medical Provider Networks To Control Selection of Doctors Treating Their Workers

In Texas and California, the workers’ compensation insurers, governmental pools and self-insured employers are turning to medical provider networks (MPN) to control the selection of doctors when an employee is injured on the job. A MPN is a group of health care providers approved by the state’s Division of Workers’ Compensation to provide medical care to employees who suffer an on-the-job injury.

The employee is still allowed to select the primary medical provider for the occupational injury, but the employee is required to select from the medical providers within the MPN. This affords the employer/insurer some control of the medical cost of the workers’ comp claim and allows the employer/insurer to influence the medical direction of the workers’ comp claim. (WCxKitz)

Burn care
Cardiology
Chiropractic
Dental
Dermatology
General Surgery
Hand Surgery
Hematology
Internal Medicine
Neurology
Neurosurgery
Oncology
Ophthalmology
Orthopedic Surgery
Orthopedics
Pain Management
Physical/Medical Rehabilitation
Podiatry (WCxKitz)
Primary Treating Physicians
Psychiatry
Psychology
Rheumatology
Sports Medicine
Toxicology
Urology

In addition to the medical specialties, the MPN will normally also contain the ancillary services of:

Acupuncture
Occupational Therapy
Physical Therapy

There are various established MPN in both Texas and California an employer or insurer can join. Also, employers and insurers has the option of creating their own MPN. If the employer or insurer does elect to create their own MPN, it must be submitted to the state Division of Workers’ Compensation for review and approval before it can be utilized. Due to the cost in creating your own MPN, most employers elect to join an existing MPN.

The MPN should be large enough that the injured employee has the opportunity for a second opinion or even a third opinion if the injured employee is unsatisfied with the medical care being provided or disagrees with the medical diagnosis. (WCxKitz)

One of the issues the employer face with a MPN is verifying the MPN has the necessary medical providers [enough to cover second and third opinions] available in their geographical area. This may not be a problem in the large metropolitan areas, but definitely becomes an issue in the rural areas. There simply may not be all the medical specialties needed in the rural areas. Before an employer joins a MPN, the geographic coverage by county and specialty should be reviewed.

When an employer joins a MPN, the employer should provide to all current employees and all future new hires a MPN employee handbook [in English or Spanish, per the employee’s preference] outlining the requirements of the program. The employer should also post at each work site a listing of the local medical providers within the MPN.

When an injury does occur, the employer should direct the injured employee to the occupational clinic (or hospital for more serious injuries) list on the MPN poster. It is also a good idea to provide the injured employee another copy of the MPN employee handbook immediately following the emergency clinic treatment or when the employee requests medical care in a non-emergency situation. (WCxKitz)

The MPN should be integrated with the utilization management and disability management programs of the insurer or self-insured. This will insure the injured employee receives all necessary medical care while controlling the cost of the medical care.

Additionally, you want the medical providers in the MPN to be proactive in returning injured employees to work, either limited duty or full duty, as soon as the employee reaches the point in the medical recovery where the employee can return to work. (WCxKitz)

The MPN allows the employer to influence the cost and the direction of the medical care throughout the life of the claim. A properly utilized MPN can have a major impact on the cost of medical care and indemnity benefits of your workers’ compensation claims.

Author Rebecca Shafer, Attorney/Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.