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A Medical Provider Network (MPN) is a list of doctors that the injured worker is limited to choose from in a workers’ comp case. This could be a general practitioner or a specialist, and either a primary or secondary doctor.
If the MPN does not have at least three doctors who specialize in the field you need, you may request the insurance company’s medical access assistant to find the specialist you need.
You can also call a specialist whom you’ve found and ask them if they accept workers’ compensation and if they’d be willing to take you on as a patient with a referral from your doctor. If they agree, let the insurance company know and give them the specialist's name and contact information. The insurance company should be willing to authorize that doctor for the consultation.
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If you disagree, you can select a second opinion and even a third opinion doctor within the MPN. You can also object to the opinion of the treating doctor and go to a Qualified Medical Evaluator instead.
Depending on your geographical region, MPNs can be deficient in certain specialties. Most Medical Provider Networks have only three doctors to choose from, and an occupational medicine physician (as opposed to a more specialized doctor) is usually the first doctor you'll be sent to.
It can also be difficult to transfer your care to another doctor in the MPN, and these shortages and limitations can sometimes allow you to request and choose a doctor outside of the network.
A medical access assistant is a staff physician for the MPN that you can contact either by phone or email to get help making appointments, sending medical records to a doctor, or reaching out to doctors on your behalf.
Medical Access Assistants are usually extremely helpful when you have questions, need help finding a specialist, or need to streamline your care and get results. Should you run into a situation where a medical access assistant doesn’t help you or respond to requests for assistance, a hearing before a workers’ comp judge could legally compel the help you need.
It’s very important for you to make and keep doctor’s appointments, and to do so regularly. If a doctor you’re seeing insists they only need to see you every six months, find a physician who will see you at least monthly. This helps provide adequate care, continually documents your injury, and provides valuable medical records that can help your case.
An attorney can help pair you with a doctor who will be truly involved, thorough, and give you the best possible care and diagnosis for your case. Your lawyer can also help you seek out alternative, qualified specialists, helping insurance companies and a judge get a full and accurate picture of your medical condition and the benefits you may be entitled to.
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