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What is a Medical Provider Network and What is Its Role in Workers’ Compensation

workers compensation provider network
workers compensation provider network

Generally, a medical provider network (MPN) is a group of medical and health care providers including hospitals, doctors, laboratories, therapists, etc., and one of their main objectives is to enter into a contract with health plans to be authorized to provide medical and health care services to their members at agreed or negotiated rates.

workers compensation provider network on the other hand refers to a group of medical and health care providers approved by the Division of Workers’ Compensation and authorized by an insurer or self-insured employer to provide medical care services to their workers who are injured on the job. Pursuant to state workers’ compensation regulations, medical provider networks are required to have a mix of practitioners in general medicine and doctors who specialize in work-related injuries and illnesses as this will ensure that employees who get sick or injured in the course of their employment are given appropriate medical treatment. 

Generally, workers’ comp medical provider networks are required to comply with these basic requirements:

  • Meet access to care standards for common occupational injuries and work-related ailments.
  • Abide by the medical treatment guidelines and allow injured workers to choose a provider in the network after their first visit.
  • Offer injured employees an opportunity to seek second and third opinions should the injured worker disagree with the diagnosis, treatment or recommendations of the treating physician.
  • Treat employees’ work-related injuries and sickness and get them back to work asap.

The alarming rate of work-related injuries in the U.S. costs businesses more than $170 billion in 2019. Do not make your company contribute to this statistic.

As an employer, you should partner with a medical management company that’s a part of a trusted workers’ compensation provider networkIt helps to ensure timely delivery of appropriate medical care services for your employees when they get sick or injured in the course of their employment. 

There are a plethora of benefits you and your employees can get for working with a medical network company that has a network of competent medical providers and years of experience in the medical and insurance industries. Their acquired knowledge can really help to get these:

  1. Quicker and easier access to quality medical treatment and care for your injured employees
  2. Strong focus on the management of your injured employees’ medical and disability needs. 
  3. Cost control. Savings in time, energy and money on your employees’ workers’ compensation claims. It’s a result of efficiency in coordinating, scheduling, reporting, and performing cost containment processes. It allows you to concentrate fully on your business and keep track of the treatment and progress of your injured workers.
  4. Access to quality medical care which will give you lots of advantages including:
  • Reduced days off work or early return to work of your injured workers
  • Reduced litigated claims 
  • Systematic coordination of your injured workers’ medical care
  • Timely and seamless access to medical appointments  
  1. Years of experience in the medical and insurance industries give a medical network company the skills to manage, navigate, and oversee the medical management aspect of workers’ compensation.   

Can an Injured Employee Choose His Own Doctor?

In case of emergency, the answer is yes. But if the element of emergency does not exist, the answer would depend on the state where your business is located. In the states of Alabama and Colorado for example, it’s the employer or insurance carrier who chooses the injured worker’s primary care provider. Employees who choose their treating physician in these states may risk non-payment of their medical benefits.

As a self-insured employer, it’s not unusual for you to want the best medical care for your injured employee and see them get back to work as early as possible. For this reason, wherever your business is located in the U.S., you should consider working with a medical network company that’s a part of a huge medical provider network. It can really help to make professional medical care easily available, reduce the cost of medical care for your injured workers, and free you up from the hassles associated with workers’ compensation claims.

Call Direct Pay Provider Network at (866) 214-5920

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