Medical Provider Networks – how the insurance companies restrict the choice of doctors to only those that will do things the insurance company way. How injured worker (applicant) biased treating physicians are removed from the MPN and only defense doctors for the most part are your only options.
Removing the biased treating physicians from the MPN panel and leaving only defense doctors for maximum is a significant step. The insurance companies who try to manipulate the doctors and their recommended treatment, these steps serve as a retort to the insurers.
Usually, insurance companies have those physicians who favor them and settle the treatment in a very cost-effective way. Well, if you are also going through a similar type of situation, it is best to contact an expert attorney, such as the PSLaw law firm in California, best for workers comp related issues.
To know more about Medical Provider Network (MPN), read the full blog.
What is a Medical Provider Network (MPN)?
Medical Provider Network (MPN) usually is a group of physicians approved by insurance companies related to Workers Compensation to provide treatment to injured people.
When an employee is injured, generally he or she is taken to the inhouse physician for treatment, who is known as the Medical Provider Network (MPN.)
There are a few exceptions which are:
The employer or the insurance didn’t provide information, about Medical Provider Network (MPN)
When the appropriate MPN doctor is not available for treatment within a reasonable distance from the workplace.
When an employee gets hurt, after the very first meeting of the employee and physician, the employer showcases the employee a list of doctors, who are within Medical Provider Network (MPN) and assigns a particular doctor for the employee’s treatment.
Afterwards, the doctor is assigned if the injured worker is not satisfied with the treatment provided by the Medical Provider Network (MPN). The employee is free to look for a second opinion from another doctor. If the second opinion also seems to be not good enough, then the worker can request for a third option.
If the third option also turns out to be not trustworthy, then the injured employee can request for Independent Medical Review.
However, if the present doctor denies the opinion of the treating physician, then the injured employee has all the rights to change the physician.
How to choose a doctor within MPN?
After the worker who is injured has filed for a worker’s compensation claim, then he or she can seek the use of Medical Provider Network MPN.
When the injured worker informs the employer about the accident, then the worker has to arrange for the medical attention immediately.
As soon as the first visit is over, the employer has to inform the employee about the Medical Provider Network (MPN), then tell them about the list of provider networks.
For instance, if you are hurt while working, you or the fellow employee first goes and informs the employer about the same to the employer. The employer then makes arrangements to provide you primary medical attention.
After you get the initial medical attention, the employer then accesses you to the MPN online list, then chooses a treating doctor who will be in charge of your health.
However, if the employer fails to provide an MPN physician, that doesn’t mean you are eligible to go to a physician of your choice.
Your Accessibility to MPN
There are a few things that an MPN must have:
At Least three doctors should be available in each specialty to treat the common injuries, which should be accessible in 30 minutes or should be within 15 miles of the workplace and should be the significant treating doctor.
A specialist physician should be available in between 60 minutes or 30 miles of all covered employees.
If a physician with these exceptions is not present in the Medical Provider Network of the employer, then the employee is free to seek help from his or her choice of doctor.
Suppose an injured worker seeks treatment from a specialist outside of MPN or we can say it doesn’t involve MPN, then it is determined on a case by case basis. The recommendation for a specialist here comes from the treating doctor.
The doctor who is not listed in MPN or outside of MPN most follow all the procedure of Workers Compensation, this includes all the treatment guidelines, that are requested through Utilization Review. With inclusion, the doctor has to accept the treating payment through the worker’s compensation insurance carrier.
Why do we have a Medical Provider Network (MPN)?
MPN or Medical Provider Network is a step taken by the insurance companies so that the cost of medical care can be controlled in worker’s compensation, whenever a worker gets injured.
In this system, the insurance companies may sometimes exclude individual physicians, believing that those physicians may request for too much treatment or provide an extended permanent disability.
But, if seen practically, then MPN usually requires a lot of physicians who can treat the injured workers, limiting the doctor’s rate doesn’t work virtually.
For this reason, frequently, the insurance companies send the workers to individual Physicians who are in favor of insurance companies and work according to the insurers. Later the insurance companies wish that the worker shouldn’t be taking any further action.
This works as a reason; it is recommended to every injured worker to change the physician within the MPN after they first meet, this helps to obtain fair treatment and compensation.
It is very much clear that the insurance companies usually opt for this Medical Provider Network (MPN) to reduce the compensation cost in Workers Comp Claim. But, the chances of not getting proper treatment is very high.
In this type of situation, where you or your loved one is injured and not even getting proper medical attention becomes a tough situation for everyone. That is when you require the help of a Workers Comp lawyer, who will fight with the insurers for your rights.
If you are looking for a law firm in California, who are capable of handling these types of cases and even suggest the best, then PSLaw Law firm is the best workers comp law firm in California, all the expert attorneys here are dedicated just to workers and their well being. The Law Firm is there is all the major cities of California like Riverside, Corona, Hemet, Temecula, Moreno Valley, Palm Springs. You can visit the nearest PSLaw Law firm.
You can feel free to call anytime, talk, get advice, and get an expert attorney!