Getting Treatment Outside a Certified Managed Health Care Plan
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Getting Treatment Outside a Certified Managed Health Care Plan

If your employer uses a certified managed health care plan, you may want to get treatment for a workplace injury outside the plan. A certified managed health care plan is an organization that manages medical care for injured workers through a network of health care providers. Your employer can decide to use a certified managed health care plan, but if it does, the law restricts the doctors you can see for a workplace injury.

The only reasons you can see a doctor outside the network of health care providers who participate in the certified managed health care plan are:

  • You live or work 30 miles away or more in the Twin Cities area, or 50 miles away or more in other areas of Minnesota, from an approved provider;
  • You visit a doctor who has either treated you at least twice in the past two years or has a history of treating you, and this doctor is able to treat you for your workplace injury; or
  • You need emergency medical care.

Many people want to see their usual doctors who they visited before their workplace injuries for treatment. Unfortunately, unless those doctors qualify for one of the exceptions listed above, the workers’ compensation insurance company will deny coverage for treatment.

You can establish that a doctor has a “history” of treatment by showing a pattern of visits over a few years. If you have a repetitive strain injury, an occupational disease, or a chronic issue made worse by work, you may have a doctor who has treated you for some time.

Getting treatment outside a certified managed care plan should be straightforward but often is not. First, tell the insurance company about the doctor you want to visit before you go to the appointment. Of course, if you need emergency medical care, go straight to the emergency room or urgent care, and talk to the insurance company later. If the insurer says that it will deny coverage for your visit, you may need to submit a written complaint or a Medical Request form. Reach out to a Minnesota workers’ compensation lawyer for help fighting for the care you need.

Need help getting workers’ compensation for your injury? Joe Osterbauer, Esq. and the Osterbauer Law Firm stand up for injured Minnesota workers’ rights. Joe’s 27 years of workers’ compensation experience and his team’s speedy service combine to get clients the results they need. To schedule a free consultation, visit Osterbauer Law Firm online or call Joe’s office at (612) 334-3434.