WHAT IS A MEDICAL PROVIDER NETWORK (MPN)?
This guide explains what a Medical Provider network is, why the insurance company requires you select a doctor within the MPN and how the insurance companies use the MPN to keep from paying you your benefits. We will also explain how you can obtain treatment outside the MPN but paid by the carrier.
WHAT IS A MEDICAL PROVIDER NETWORK (MPN)?A Medical Provider Network (MPN) is a list of doctors compiled by an insurance company that have agreed to provide medical treatment to injured workers at a fixed rate or price. So the doctors have private contracts with the insurance company who is paying for all of your medical treatment for your work injury. These doctors have a built in economic incentive to please the insurance company and thereby continue to receive business from the insurance company in the form of patient referrals.
HOW INSURANCE COMPANIES USE THE MPN DOCTOR TO KEEP FROM PAYING YOU BENEFITS.Insurance companies are always striving for ways to more accurately predict and protect profits. One of the ways they do this is to limit the fees a doctor can charge for a particular service. Another is to control the doctors opinions on treatment needs, ability to return to work and levels of long term impairment. If you have ever had a doctor tell you "I cant take you off work", you are experiencing the opinion of a doctor that has been influenced by someone else. That could be the claims adjuster directly or indirectly through fear of being removed from the MPN and thereby potentially losing a source of business( patients).
HOW CAN I OBTAIN TREATMENT OUTSIDE A MPN?In most cases you will be required to treat within the MPN. However if the carrier has delayed a referral to a doctor or has failed to notify the injured worker of the existence of the MPN it may be possible to argue for treatment outside the MPN. This will likely require some litigation as carriers rarely admit errors of this type.