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Thread Title: This may have been addressed before, but...
Created On Friday June 27, 2008 3:40 PM

inquiring mind
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Friday June 27, 2008 3:40 PM

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EE is with a PTP who is part of the MPN. PTP prescribed chiro treatment, but C/A wants EE to select a Chiro who is part of their MPN to provide the treatment.

My understanding is as long as the PTP is within the MPN, whoever will provide the treatment (i.e. physical therapy, acupuncture, chiro manipulation) does not necessarily have to be a member of MPN. Am I correct?

Thanks!

IM

jakelast@aol.com
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Saturday June 28, 2008 1:35 PM

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Generally speaking when an employer had contracted with an MPN all of the medical care is to be provided within the MPN. MPN's are required to have sufficient specialists to treat common work related injuries which includes chiropractors. It is possible for an MPN plan to provide that an employee can receive some treatment outside the network but there would have to be a provision in the MPN plan to do so.

Additionally LC 4616.3(d)(2) allows "Treatment by a specialist who is not a member of the medical provider network may be permitted on a case-by-case basis if the medical provider network does not contain a physician who can provide the approved treatment and the treatment is approved by the employer or the insurer."

Jake Jacobsmeyer
Shaw, Jacobsmeyer, Crain, Claffey & Nix

inquiring mind
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Monday June 30, 2008 11:25 AM

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