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FAQ’s Regarding Medical Provider Networks

1. Q. What is a Medical Provider Network (MPN)?

A. An MPN is a network of medical providers such as physicians and hospitals that have been certified by the State of California Division of Workers’ Compensation, to provide health care to injured workers. It mandates treatment by those providers unless an employee has pre-designated their treating physician prior to a work related injury. In the case of an emergency, employees are encouraged to seek the nearest medical emergency services.

2. Q. Why do I have to go to a County Doctor?

A. As referenced in the answer portion of # 11 above, the purpose of the MPNs is to provide the same quality care and help contain overcharging in the Workers’ Compensation system. The MPNs are not made up of “County Doctors”, but professional health care providers who also provide their services to the public and other entities.

3. Q. Why are the procedures for workers’ compensation being changed?

A. The passage of SB899 allows self-insured employers like Los Angeles County 4to offer MPNs. Labor Code section 4600 provides that medical provider networks may be established by employers or insurers on or after Jan. 1, 2005. The standards must also include a process for allowing employees a choice of medical provider in the networks (after the first visit) and for getting second and third opinions. If an employer or insurer uses medical provider networks, covered employees would receive their medical care in those networks, unless a predesignated physician is chosen prior to an injury. Medical provider networks must be approved by DWC before they can be used.

4. Q. How do I access a list of the MPN providers?

A. You can access the County’s MPNs to choose an initial and/or on-going treatment provider within the MPNs by clicking the “Initial Treatment Centers” or “Provider Network” in the navigation section of this website (to the left of your screen).

5. Q. I live in a rural area outside of Los Angeles County. How do I get treatment?

A. The County is required to provide occupational health providers within 30 minutes or 15 miles of an employee’s residence or workplace. If you live outside of that service area, a provider will be found for you, so that the required treatment guidelines are followed. If you need assistance, please contact your Third Party Administrator (TPA), Return-To-Work (RTW) Coordinator, or the Chief Executive Office (CAO) Disability Management Unit, for assistance.

6. Q. How do I change physicians?

A. After your initial referral, you can change treating medical providers within the
MPNs. If you have a recurring treatment, a letter should have been provided to you that explained the process for changing physicians. This process is available on-line at the County of Los Angeles MPNs website (this website), for your continued reference:
http://ceo.lacounty.gov/mpn/default.htm or you may go through your department’s RTW Coordinator.

7. Q. Can I choose a physician that I have not treated with to be my predesignated doctor?

A. No, your predesignated physician must have treated you before your work related injury or illness and must maintain your medical records.

8. Q. What if I don’t agree with the treatment recommended by the medical provider on the County’s MPNs?

A. If you dispute treatment or diagnosis, you can request a change of medical provider during the course of your medical treatment. Your request must be made to your TPA.

9. Q. What if I need immediate non-emergency treatment?

A. The County is required to provide an appointment for initial treatment within three days of receipt of the claim for non-emergency treatment. Therefore, for non-emergency treatment, you must wait until business hours to receive your initial treatment and initial referral to the County’s MPNs.

10. Q. I don’t trust the County, how can I be sure they are not going to send
me to a biased medical provider?

A. The State of California has formulated strict rules per the California Labor Code that the County must abide by for setting-up and maintaining it’s MPNs. Specifically, the County cannot offer the doctor any compensation to delay or deny a claim. Since all treatment must be compliant with the ACOEM guidelines, the treatment standards are built into the County’s MPNs to assure employees quality medical care. There are over 40,000 medical providers in the County’s MPNs and all are certified based upon California State standards.

11. Q. What if the County’s MPNs do not have the specialist I need to treat my
condition?

A. If you have problems locating a specialist within the County’s MPNs, please contact your TPA adjuster, department RTW Coordinator or refer them to the MPN website.

12. Q. Can I have one doctor for each specialty?

A. Yes, you can have access to one doctor for each specialty as long as treatment is provided according to the guidelines and the treating medical provider is part of the County’s MPNs.

13. Q. Can I predesignate Kaiser?

A. No, at this time you cannot predesignate Kaiser. The predesignation rules are still pending.

14. Q. Can I predesignate my chiropractor?

A. No, chiropractors cannot be predesignated at this time.