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Workers' Compensation Attorney Elizabeth A. Hudson

Workers' Compensation news, insights, and information for San Francisco Bay Area residents.

Frustrated with Medical Provider Networks?

workers compensation lawyer san franciscoFrustrated with Medical Provider Networks (MPN) and getting an appointment to see a treating physician or specialist? Try asking the MPN and/or insurance carrier to assign a Medical Access Assistant (MAA) to your case.

The Department of Industrial Relations’ (DIR) website has a list of every approved MPN. That list can be found here:

https://www.dir.ca.gov/dwc/mpn/ListApprovedMPN_Alpha.pdf

The DIR requires each MPN to post a roster of every approved MPN doctor on the MPN’s website. The roster is supposed to be updated quarterly, and must contain information on how to contact the doctors as well as the MPN’s Medical Access Assistant.

A Medical Access Assistant (MAA) is a person assigned to help the injured employee find an available MPN doctor of the employee’s choice. They must be available from 7 AM to 8 PM Pacific Standard Time, Monday through Saturday. It is their duty to contact the doctor’s offices during regular business hours and schedule appointments. (See Labor Code §4616(a)(5) and Title 8, California Code of Regulations §§9767.1(a)(16) and 9767.5(h).)

An initial non-emergency care appointment must be scheduled within 3 business days and a non-emergency specialists care be scheduled within 20 business days. (See Title 8, California Code of Regulations §9767.5(f) and (g).) “If an MPN medical access Assistant is unable to schedule a timely medical appointment with an appropriate specialist within 10 business days of an employee’s request, the employer shall permit the employee to obtain necessary treatment with an appropriate specialist outside of the MPN.” Title 8, California Code of Regulations §9767.5(g).

Once you have located the MPN website information, search the list of doctors for an appropriate doctor or specialist, and select. Try to find the MAA’s contact information on the MPN website, and if you can find it, notify the MAA that treatment is needed, provide the name of the doctor selected, and request that they schedule an appointment. If you cannot find the MAA’s contact information on the MPN website, write to the carrier with a demand that the MAA from their MPN schedule an appointment within the time limits provided by the Regulations. If the MAA does not respond, consider filing a Request for Expedited Hearing with the WCAB with a demand that treatment with a doctor of your choice be authorized outside of the MPN.

If you encounter problems with an MPN, you have the option of filing a Medical Provider Network Complaint, which can be found here:

https://www.dir.ca.gov/dwc/DWCPropRegs/MPNRegulations/MPN-Final-%20Regulations/FORMS/MPNComplaintForm9767.16.5.Strikeout.pdf

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