What Is a Certified Managed Care Plan?
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What Is a Certified Managed Care Plan?

Some Minnesota employers participate in a certified managed care plan, a special kind of health care plan for injured workers. If your employer has a managed care plan, learn what to expect when you file a workers’ compensation claim.

Certified managed care plans are organizations that manage medical care for injured workers. These plans receive state certification to operate. If your employer participates in a certified plan, it must notify you that you are covered so that you can use the plan’s health care services. Employers should post a written notice in the workplace explaining how to get treatment through the plan and how to contact plan representatives. You can ask your employer or plan representatives for a list of medical providers who are in the plan.

Employees whose employers participate in a certified managed care plan must use the plan’s approved providers for treatment in most cases. If your employer participates in a managed care plan or network that is not certified by the state, you do not have to use those health care services unless you choose to do so. The three certified plans in Minnesota are Corvel, GENEX Services Inc., and HealthPartners.

Under certain circumstances, you do not have to visit an approved provider in the plan:

  • You do not live or work near 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.

To live or work too far away from an approved provider, you must be 30 miles away or more in the Twin Cities are or 50 miles away or more in other areas of Minnesota.

If you visit a provider not approved by the plan and none of the above exceptions apply, your employer’s workers’ compensation insurance company probably will not pay for your medical expenses. Certified plans must include a variety of treating doctors, such as medical doctors, chiropractors, osteopaths, and physical therapists. Some plans assign injured workers to a particular clinic for initial treatment, and some plans require them to work with a case manager who is supposed to coordinate treatment.

All certified managed care plans must have a method of resolving disputes as to treatment and medical services. If you are having problems getting medical care with a managed care plan, contact a Minnesota workers’ compensation attorney for help.

Fighting with the insurance company over necessary medical care for your workplace 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.