IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS MEDICAL PROVIDER NETWORK (MPN) NOTIFICATION If yu are injured at wrk, Califrnia Law requires yur emplyer t prvide and pay fr medical treatment. Yur emplyer will prvide this medical care thrugh a Wrkers Cmpensatin Medical Prvider Netwrk (MPN). This dcument includes frequently asked questins abut the prgram and yur rights in chsing treatment fr wrk-related injuries and illnesses. Yur emplyer is using the Travelers TCT CA MPN. 1. What is a Medical Prvider Netwrk (MPN)? A Medical Prvider Netwrk is a grup f health care prviders (physicians and ther types f prviders) that will manage and direct any medical care yu receive if yu are injured at wrk. The MPN als includes ancillary prviders including a pharmacy netwrk and durable medical equipment prviders. The prviders in the MPN specialize in wrk related injuries and illnesses and meet Califrnia required access t care standards. The Califrnia Divisin f Wrkers Cmpensatin (DWC) MPN access t care standards require that an MPN plan prvide: at least three physicians f each specialty expected t treat wrkers cmpensatin injuries; has primary treating prviders within 15 miles r 30 minutes and specialty care prviders within 30 miles r 60 minutes frm either yur wrk r residence; that after ntifying the emplyer abut the injury, an injured emplyee will be able t get an appintment fr the first treatment visit fr nn-emergency services within three business days; and the appintment with a specialist will be made within 20 business days fllwing the insurer s receipt f request fr treatment. Further, the regulatins require MPN prviders t use medical treatment guidelines adpted by the DWC in making any decisins related t medical care r treatment. This MPN plan cmplies with DWC requirements and in the event that yu need medical care in cnnectin with a wrkers cmpensatin claim, it is likely that yu will receive this care frm prviders within the MPN. Yu can get general infrmatin regarding the MPN frm the website www.mywcinf.cm: In the State Resurces sectin, select Califrnia in the drp-dwn bx Click the G buttn 2. Hw d I find ut which dctrs, pharmacies r ther medical prviders are in the MPN? Yu can get a reginal list f all MPN prviders in yur area. At minimum, the reginal list must include a list f all MPN prviders within 15 miles f yur wrkplace and/r residence r a list f all MPN prviders within the cunty where yu live and/r wrk. Yu may chse which list yu wish t receive. Yu als have the right t btain a list f all the MPN prviders upn request. There are several methds fr lcating MPN prviders. Yu may: Lg n t the website at: www.mywcinf.cm Click the Find a Lcal Netwrk Prvider link Cntact yur Case Manager (Claim r Medical) Cntact the MPN Medical Access Assistant Cntact yur emplyer Yu can access the rster f all treating physicians in the MPN by ging t the website at www.mywcinf.cm:
Click the Find a Lcal Netwrk Prvider link Click n the CA MPN Rster f Treating Physicians tab The MPN Medical Access Assistant will be able t help yu find available MPN prviders f yur chice and help yu if yu are having truble getting an appintment with an MPN prvider. The MPN Medical Access Assistant is available t schedule medical appintments during dctrs nrmal business hurs and t assist yu frm 7:00 a.m. t 8:00 p.m. Pacific time, Mnday thrugh Saturday at 800-287-9682, r by fax at (877) 890-3258, r by email t CAMPN@travelers.cm. Assistance is available in English and Spanish. If yu cme acrss any inaccuracies in a prvider listing, please reprt the inaccuracies t the MPN Medical Access Assistant by calling 800-287-9682 r by email t CAMPN@travelers.cm. 3. What happens if I get injured at wrk? If yu incur a wrk-related injury r illness that is an emergency either call 911 r g t the nearest emergency medical center. Yu shuld ntify yur emplyer as sn as pssible fllwing any emergency treatment. If yur injury r illness is nt an emergency, ntify yur emplyer that yu have a wrk-related injury in a reasnable time fllwing the date f injury. Yur emplyer r insurer will arrange an initial appintment with a dctr within the MPN. 4. Hw d I chse a prvider? After yur first visit with an MPN prvider t treat yur wrk-related injury r illness, yu may either cntinue treatment with this dctr r chse anther MPN prvider that is apprpriate t treat yur injury. If needed, yu may chse a specialist r ask the treating dctr t refer yu t a specialist fr treatment. Yu may cntinue t chse dctrs within the MPN fr all f yur medical care fr this injury. If yu need help in chsing an MPN dctr r have truble getting an appintment with a dctr within the MPN, please cntact yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant fr help. If yu need t see a type f specialist that is nt available in the MPN, yu have the right t see a specialist utside f the MPN. 5. Can I change prviders? Yes. Yu can change prviders within the MPN fr any reasn, but the prviders yu chse shuld be apprpriate t treat yur injury. Please cntact yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant if yu want t change yur treating physician. 6. What if there are n prviders in my area? The MPN has prviders available thrughut the state f Califrnia. If yu are unable t find an apprpriate treating physician r specialist available in yur area, please cntact yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant fr help. If there are n MPN prviders in the apprpriate specialty available t treat yur injury within the distance and timeframe requirements, then yu will be allwed t seek the necessary treatment utside f the MPN. 7. What if I am authrized by my emplyer t temprarily wrk r travel utside f the MPN gegraphic service area? If yur emplyer has authrized yu t temprarily wrk r travel utside the MPN gegraphic service area and the need fr nn-emergency medical care arises, yu may treat with a prvider f yur chice. Yu may als cntact the MPN Medical Access Assistant r yur Case Manager (Claim r Medical). Yu will be prvided with a chice f three physicians wh are utside f the MPN gegraphic service area fr care. These prviders will be selected by either yur primary treating physician, wh is participating in the MPN, r by the MPN Medical Access Assistant. If yur injury requires emergency care, call 911 r g t the nearest emergency medical treatment center.
8. What if I decide t temprarily r permanently reside utside f the MPN gegraphic service area during my recvery? If yu are a current emplyee temprarily living utside the MPN gegraphic service área r are a frmer emplyee permanently residing utside f the MPN gegraphic service area and the need fr nn-emergency medical care arises, yu may treat with a prvider f yur chice. Yu may als cntact yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant. Yu will be prvided with a chice f three physicians wh are utside f the MPN gegraphic service area t chse frm fr care. These prviders will be selected by yur primary treating physician, wh is participating in the MPN, yur Case Manager, r by the MPN Medical Access Assistant. If yur injury requires emergency care, call 911 r g t the nearest emergency medical treatment center. 9. What if I am already being treated fr a wrk-related injury befre the MPN begins? The MPN has a Transfer f Care plicy, which will determine if yu can cntinue being temprarily treated fr an existing wrk-related injury by a physician utside f the MPN befre yur care is transferred int the MPN. If yur current dctr is nt r des nt becme a member f the MPN, then yu may be required t see a MPN physician. Hwever, if yu have prperly predesignated a primary treating physician, yu cannt be transferred int the MPN. (If yu have questins abut predesignatin, ask yur supervisr.) If yur Case Manager (Claim r Medical) decides t transfer yu int the MPN, yu and yur primary treating physician will receive a letter ntifying yu f the transfer. If yu meet certain cnditins, yu may qualify t cntinue treating with a nn-mpn physician fr up t a year befre yu are transferred int the MPN. Yu may qualify fr cntinuing treatment with yur nn-mpn prvider thrugh transfer f care fr up t a year if yur injury r illness meets any f the fllwing cnditins: (Acute) The treatment fr yur injury r illness will be cmpleted in less than 90 days; (Serius r Chrnic) Yur injury r illness is ne that is serius and cntinues fr at least 90 days withut full cure r wrsens and requires nging treatment. Yu may be allwed t be treated by yur current treating dctr fr up t ne year, until a safe transfer f care can be made. (Terminal) Yu have an incurable illness r irreversible cnditin that is likely t cause death within ne year r less. (Pending Surgery) Yu already have a surgery r ther prcedure that has been authrized by yur emplyer r insurer that will ccur within 180 days f the MPN effective date. Yu can disagree with the decisin t transfer yur care int the MPN. If yu dn t want t be transferred int the MPN, ask yur primary treating physician fr a medical reprt n whether yu have ne f the fur cnditins stated abve t qualify fr a pstpnement f yur transfer int the MPN. Yur primary treating physician has 20 calendar days frm the date f yur request t give yu a cpy f his/her reprt n yur cnditin. If yur primary treating physician des nt give yu the reprt within 20 calendar days f yur request, yur Case Manager can transfer yur care int the MPN and yu will be required t use an MPN physician. Yu will need t give a cpy f the reprt t yur Case Manager (Claim r Medical) if yu wish t pstpne the transfer f yur care. If yu r yur Case Manager disagrees with yur dctr s reprt n yur cnditin, yu r yur Case Manager can dispute it. See the cmplete Transfer f Care plicy fr mre details n the dispute reslutin prcess.
Fr a cpy f the Transfer f Care plicy, in English r Spanish, ask yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant. 10. What if I am being treated by a MPN dctr wh decides t leave the MPN? The MPN has a written Cntinuity f Care plicy that will determine whether yu can temprarily cntinue treatment fr an existing wrk injury with yur dctr if yur dctr is n lnger participating in the MPN. If yur Case Manager (Claim r Medical) decides that yu d nt qualify t cntinue yur care with the nn-mpn prvider, yu and yur primary treating physician will receive a letter ntifying yu f this decisin. If yu meet certain cnditins, yu may qualify t cntinue treating with this dctr fr up t a year befre yu must chse a MPN physician. Yu may qualify fr cntinuing treatment with yur nn-mpn prvider thrugh cntinuity f care fr up t a year if yur injury r illness meets any f the fllwing cnditins: (Acute) The treatment fr yur injury r illness will be cmpleted in less than 90 days; (Serius r Chrnic) Yur injury r illness is ne that is serius and cntinues fr at least 90 days withut full cure r wrsens and requires nging treatment. Yu may be allwed t be treated by yur current treating dctr fr up t ne year, until a safe transfer f care can be made. (Terminal) Yu have an incurable illness r irreversible cnditin that is likely t cause death within ne year r less. (Pending Surgery) Yu already have a surgery r ther prcedure that has been authrized by yur emplyer r insurer that will ccur within 180 days f the terminatin f cntract date between the MPN and yur dctr. Yu can disagree with yur Case Manager s decisin t deny yu Cntinuity f Care with the terminated MPN prvider. If yu want t cntinue treating with the terminated dctr, ask yur primary treating physician fr a medical reprt n whether yu have ne f the fur cnditins stated in the bx abve t see if yu qualify t cntinue treating with yur current dctr temprarily. Yur primary treating physician has 20 calendar days frm the date f yur request t give yu a cpy f his/her medical reprt n yur cnditin. If yur primary treating physician des nt give yu the reprt within 20 calendar days f yur request, yur Case Manager s decisin t deny yu Cntinuity f Care with yur dctr wh is n lnger participating in the MPN will apply, and yu will be required t chse a MPN physician. Yu will need t give a cpy f the reprt t yur Case Manager if yu wish t pstpne the selectin f anther MPN dctr fr yur cntinued treatment. If yu r yur Case Manager disagrees with yur dctr s reprt n yur cnditin, yu r yur Case Manager can dispute it. See the cmplete Cntinuity f Care plicy fr mre details n the dispute reslutin prcess. Fr a cpy f the Cntinuity f Care plicy, in English r Spanish, ask yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant. 11. What if I disagree with my dctr abut medical treatment? If yu disagree with yur dctr r wish t change yur dctr fr any reasn, yu may chse anther dctr within the MPN. If yu disagree with either the diagnsis r treatment prescribed by yur dctr, yu may ask fr a secnd pinin frm anther dctr within the MPN. If yu want a secnd pinin, yu must cntact yur Case Manager (Claim r Medical) and tell them yu want a secnd pinin. The MPN shuld give yu at least a reginal MPN prvider list, based n the specialty r recgnized expertise in treating the particular injury r cnditin in questin, frm which yu can chse a
secnd pinin dctr. T get a secnd pinin, yu must chse a dctr frm the MPN list and make an appintment within 60 days. Yu must tell yur Case Manager (Claim r Medical) f yur appintment date, and they will send the dctr a cpy f yur medical recrds. Yu can request a cpy f yur medical recrds that will be sent t the dctr. If yu d nt make an appintment within 60 days f receiving the reginal prvider list, yu will nt be allwed t have a secnd r third pinin with regard t this disputed diagnsis r treatment f this treating physician. If the secnd-pinin dctr feels that yur injury is utside f the type f injury he r she nrmally treats, the dctr's ffice will ntify yur Case Manager (Claim r Medical) and yu. Yu will get anther list f MPN dctrs r specialists s yu can make anther selectin. If yu disagree with the secnd pinin, yu may ask fr a third pinin. If yu request a third pinin, yu will g thrugh the same prcess yu went thrugh fr the secnd pinin. Remember that if yu d nt make an appintment within 60 days f btaining anther MPN prvider list, then yu will nt be allwed t have a third pinin with regard t this disputed diagnsis r treatment f this treating physician. If yu disagree with the third-pinin dctr, yu may ask fr an MPN Independent Medical Review (IMR). Yur Claim Case Manager will give yu infrmatin n requesting an Independent Medical Review and a frm at the time yu select a third-pinin physician. If either the secnd r third-pinin dctr r Independent Medical Reviewer agrees with yur need fr a treatment r test, yu may be allwed t receive that medical service frm a prvider within the MPN r if the MPN des nt cntain a physician wh can prvide the recmmended treatment, yu may chse a physician utside the MPN within a reasnable gegraphic area. 12. What if I have a prescriptin I need t fill? The MPN includes dctrs, as well as pharmacies. If yur MPN treating physician prescribes a medicatin, yu must btain yur prescriptins thrugh a netwrk pharmacy. Healthesystems, ur Pharmacy Benefit Manager, will electrnically prcess yur prescriptin with n ut f pcket expense t yu. T access a cmplete listing f MPN pharmacies, please lg n t www.mywcinf.cm and click n the Find a Netwrk Prvider link. Yu can als visit the Healthesystems website at www.healthesystems.cm. If yu need assistance finding an MPN pharmacy, please cntact yur Case Manager (Claim r Medical) r the MPN Medical Access Assistant. T assist yu and the pharmacists with prcessing yur medicatin nline yu will need the fllwing: Member ID (Claim Number + TRV) Bin Number 012874 Healthesystems Pharmacy Help desk (877) 528-9497 If yu have questins r cncerns regarding yur pharmacy benefits, please cntact yur case manager (Claim r Medical). 13. What if I have questins r need help understanding the MPN? Yu will need t refer t the Travelers TCT CA MPN whenever yu have questins r requests abut the MPN. Yu may always cntact yur Case Manager r the MPN Medical Access Assistant if yu need help r further explanatin abut yur medical treatment. The MPN Medical Access Assistant can be reached at: 800-287-9682.
The MPN Cntact is als able t answer questins abut the use f the MPN and will address any cmplaints regarding the MPN. The MPN Cntact can be reached by phne at 800-287- 9682 r by email at CAMPN@travelers.cm. DWC Infrmatin & Assistance Officer: If yu have cncerns, cmplaints r questins regarding the MPN, the ntificatin prcess, r yur medical treatment f a wrk-related injury r illness, yu can call the Infrmatin and Assistance Officer at the Divisin f Wrkers' Cmpensatin at 1-800-736-7401. Independent Medical Review: If yu have questins abut the Independent Medical Review prcess r the Independent Medical Reviewer, yu may cntact the Divisin f Wrkers Cmpensatin s Medical Unit at: Divisin f Wrkers Cmpensatin s Medical Unit P.O. Bx 71010 Oakland, CA 94612 (510) 286-3700 r (800) 794-6900