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California allows the workers compensation insurers and self-insured employers to utilize a Medical Provider Network (MPN) for the treatment of on-the-job injuries and work-related illnesses. The MPN is an association or network of clinics, physicians, hospitals and other medical providers ? under contract with the MPN ? who specialize in the treatment of workers compensation injuries and occupational illnesses. The advantage of the MPN to the employer is the employee is treated by a medical provider who specializes in work-related injuries.

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California MPNs are designed to provide services throughout the state. It is customary for the MPN to offer:
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1.????? A primary care physician within 15 miles or 30 minutes of the employee's residence or job site.

2.????? All other medical services within 30 miles or 60 minutes or the employee's residence or job site.

3.????? Emergency medical care services.

4.????? Medical care in rural areas (they have alternative distance and time standards and, in some situations, allow out-of-network medical providers or non-contract medical providers).

5.????? Medical care for the employee who is working or traveling outside of their home geographical area (but still within the State of California.)(WCxKit)

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The employer can arrange initial medical evaluation and treatment. California law gives the employee the right to choose their doctor within the MPN after the first medical visit and after 30 days. If the employee is unhappy with the choice of a physician, they can elect to change doctors but must stay within the MPN.

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If the employee is unhappy with the diagnosis or the treatment they receive for their injury, they have the right to ask for a second opinion from another physician within the MPN. The employee is required to make an appointment within 60 days of requesting a second opinion. If the employee is unhappy with both their original doctor's opinion and the second doctor's opinion, they are entitled to a third opinion in California.

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If the employee is unhappy with the first opinion, second opinion, and third opinion, the employee may file a request for an Independent Medical Review (IMR) with the California Division of Workers Compensation administrative director. The administrative director will assign an independent medical reviewer. The independent medical reviewer will conduct either a physical examination or a medical-records review. If the independent medical reviewer agrees with the employee, the employee can select a physician who does not have to be a part of the MPN. In this case, the employer/insurer is responsible for the medical care cost.

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Most MPNs will offer medical management in which a nurse case manager will work with the employee, the employer, and medical providers to get the employee back to work as quickly as feasible. Some MPNs also offer a vocational specialist who works with the employee to retrain them for another occupation when they are physically unable to return to the their prior job.

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An insurance company or self-insured employer can create their own MPN or join one of the MPNs that have already been established. The benefits to the employer who joins a MPN include:
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1.????? Lower medical cost ? The MPN contracts with the medical providers for the cost of the medical fees which are lower than the Medical Fee Schedule used in California. On average the medical fees are approximately 10 percent lower through a MPN.

2.????? Qualified medical providers ? The medical providers within the MPN have the credentials and experience to properly provide medical care to injured workers. This eliminates the medical providers who allow the injured employee to dictate how long they will be off work.

3.????? Medical control throughout the claim ? When an employer has a MPN, the employee must treat within the MPN throughout the life of the claim (with certain exceptions, see above) unless the employee has pre-designated their primary treating physician (the large majority do not).

4.????? Elimination of chiropractors and acupuncturists: if the employer has a MPN, the employee can only pre-designate a medical doctor or doctor of osteopath. Without a MPN, the employee can pre-designate their chiropractor or acupuncturist.(WCxKit)

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Medical Provider Networks provide medical cost control. The long term impact for the employer is lower overall cost of workers compensation insurance. We recommend for all California employers to have a Medical Provider Network.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

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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.

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?2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

This entry was posted on Wednesday, September 14th, 2011 at 1:25 pm and is filed under Medical Cost Containment & Managed Care, Medical Issues. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Source: http://blog.reduceyourworkerscomp.com/2011/09/california-medical-provider-networks/?utm_source=rss&utm_medium=rss&utm_campaign=california-medical-provider-networks

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