PROVIDER NETWORK RULES for CALIFORNIA

Provider Selection
Unless the employer has an MPN, or an HCO, the employer chooses the treating provider for the first 30 days from the date of injury. There after the employee chooses.


Pre-designation is only available if all of the following conditions are satisfied:

  1. The employer provides group health coverage;
  2. The physician is the employee's primary care physician (must be a licensed physician and surgeon) and has previously directed the medical treatment of the employee and who retains the employee's medical records, including his/her medical history.
  3. The physician agrees to be pre-designated.
  4. The employee notifies the employer in writing prior to the date of injury that he/she has a personal physician.
PROVIDER NETWORK RULES for CALIFORNIA HEALTH CARE ORGANIZATION (HCO)


Provider Selection
The employer chooses the treating provider.

If the employer has contracted with an HCO, the employee is precluded from selecting a physician of his or her choice unless they have "pre-designated" a physician prior to the injury occurring.

Depending on the employee benefits, once in the HCO, the HCO can manage an injured worker from 90-180 days.

Provider Lists
Provider lists and directories may be utilized.


PROVIDER NETWORK RULES FOR CALIFORNIA MPN


Provider Selection
The employer chooses the initial treating provider. The employee may choose a physician within the MPN after the first visit.

Provider Lists
Provider lists and directories may be utilized