County of Orange MPN 1 - Important Information about Medical Care

County of Orange – County of Orange MPN

Complete Written Employee Notification Re: Medical Provider Network

(Title 8, California Code of Regulations, section 9767.12)

California law requires your employer to provide and pay for medical treatment if you are injured at work.

Your employer or insurer has chosen to provide this medical care by using a Workers’ Compensation

physician network called a Medical Provider Network (MPN). This MPN is administered by Sedgewick

Claims Administrators. This notification tells you what you need to know about the MPN program and

describes your rights in choosing medical care for work-related injuries and illnesses.

● What happens if I get injured at work?

In case of an emergency, you should call 911 or go to the closest emergency room.

If you are injured at work, notify your employer as soon as possible. Your employer will provide you with a

claim form. When you notify your employer that you have had a work-related injury, your employer or

insurer will make an initial appointment with a doctor in the MPN.

● What is an MPN?

A Medical Provider Network (MPN) is a group of health care providers (physicians and other medical

providers) used by your employer or its claims administrator to treat workers injured on the job. MPNs must

allow employees to have a choice of provider(s). Each MPN must include a mix of doctors specializing in

work-related injuries and doctors with expertise in general areas of medicine.

● What MPN is used by my employer?

Your employer is using the County of Orange MPN with the identification number MPN ID: 3208. You must

refer to the MPN name and the MPN identification number whenever you have questions or requests about

the MPN.

● Who can I contact if I have questions about my MPN?

The MPN Contact listed in this notification will be able to answer your questions about the use of the MPN

and will address any complaints regarding the MPN.

MPN Contact Toll Free # (877) 854-3353.

General information regarding the MPN can also be found at the following website:

https://netbyd.com/OrangeCountyMPN/

● What if I need help finding and making an appointment with a doctor?

The MPN’s Medical Access Assistant will help you find available MPN physicians of your choice and can

assist you with scheduling and confirming physician appointments. The Medical Access Assistant is

available to assist you Monday through Saturday from 7am-8pm (Pacific), excluding Sundays and holidays

and schedule medical appointments during doctors’ normal business hours. Assistance is available in

English and in Spanish.

Medical Access Assistant (MAA)

Toll Free Number: (877) 854-3353

Email: mpninfo@netbyd.com

Fax: (209) 879-9387

Important Information about Medical Care if You Have a Work-Related

Injury or Illness

County of Orange – County of Orange MPN

● How do I find out which doctors are in my MPN?

You can get a regional list of all MPN providers in your area by calling the MPN Contact or by going to our

website at: https://netbyd.com/OrangeCountyMPN/

At minimum, the regional list must include a list of all

MPN providers within 15 miles of your workplace and/or residence or a list of all MPN providers within the

county where you live and/or work. You may choose which list you wish to receive. You also have the

right to obtain a list of all the MPN providers upon request.

You can access the roster of all treating physicians and the roster of all participating proivders in the MPN

by going to the website at: https://netbyd.com/OrangeCountyMPN/

● How do I choose a provider?

Your employer will arrange the initial medical evaluation with a MPN physician. After the first medical visit,

you may continue to be treated by that doctor, or you may choose another doctor from the MPN. You may

continue to choose doctors within the MPN for all of your medical care for this injury.

If appropriate, you may choose a specialist or ask your primary treating physician for a referral to a

specialist. Some specialists will only accept appointments with a referral from the primary treating

physician. Such specialists might be listed as “by referral only” in your MPN directory.

If you need help in finding a doctor or scheduling a medical appointment, you may call the Medical Access

Assistant.

● Can I change providers?

Yes. You can change providers within the MPN for any reason, but the providers you choose should be

appropriate to treat your injury. Contact the MPN Contact or your claims adjuster if you want to change

your treating physician.

● What standards does the MPN have to meet?

The MPN has providers for the following counties in California: Los Angeles, Orange, Riverside, San

Bernardino, San Diego and Ventura.

The MPN must give you access to a regional list of providers that includes at least three physicians in each

specialty commonly used to treat work injuries/illnesses in your industry. The MPN must provide access to

three primary treating physicians and a hospital or an emergency healthcare facility within 30 minutes or

15 miles and specialists within 60 minutes or 30 miles of where you work or live.

If you live in a rural area or an area where there is a health care shortage or if there are no MPN providers

available within 30 miles of your residence or workplace location, you will be allowed to obtain services

from a provider outside of the MPN, within a reasonable geographic area.

After you have notified your employer of your injury, the MPN must provide initial treatment within 3 business

days. If treatment with a specialist has been authorized, the initial appointment with the specialist must be

provided to you within 20 business days of your request. If the appointment with the specialist cannot be

scheduled within 10 business days of your request, the employer shall permit the employee to obtain

treatment with an appropriate specialist outside of the MPN.

If you have trouble getting an appointment with a provider in the MPN, contact the Medical Access Assistant.

● What if there are no MPN providers where I am located?

If you are a current employee living in a rural area or temporarily working or living outside the MPN service

area, or you are a former employee permanently living outside the MPN service area, the MPN or your

treating doctor will give you a list of at least three physicians who can treat you. The MPN may also allow

County of Orange – County of Orange MPN

you to choose your own doctor outside of the MPN network. Contact your MPN Contact for assistance in

finding a physician or for additional information.

● What if I need a specialist that is not available in the MPN?

If you need to see a type of specialist that is not available in the MPN, you have the right to see a specialist

outside of the MPN.

● What if I disagree with my doctor about medical treatment?

If you disagree with your doctor or wish to change your doctor for any reason, you may choose another

doctor within the MPN.

If you disagree with either the diagnosis or treatment prescribed by your doctor, you may ask for a second

opinion from another doctor within the MPN. If you want a second opinion, you must contact the MPN

Contact or your claims adjuster and tell them you want a second opinion. The MPN should give you at

least a regional or full MPN provider list from which you can choose a second opinion doctor. To get a

second opinion, you must choose a doctor from the MPN list and make an appointment within 60 days.

You must tell the MPN Contact or your claims adjuster of your appointment date, and the MPN will send

the doctor a copy of your medical records. You may also request a copy of your medical records that will

be sent to the doctor.

If you do not make an appointment within 60 days of receiving the regional provider list, you will not be

allowed to have a second or third opinion with regard to this disputed diagnosis or treatment of the treating

physician.

If the second-opinion doctor feels that your injury is outside of the type of injury he or she normally treats,

the doctor's office will notify the MPN Contact or your claims adjuster and you. You will get another list of

MPN doctors or specialists so you can make another selection.

If you disagree with the second opinion, you may ask for a third opinion. If you request a third opinion, you

will go through the same process you went through for the second opinion.

Remember that if you do not make an appointment within 60 days of obtaining another MPN provider list,

then you will not be allowed to have a third opinion with regard to this disputed diagnosis or treatment of

this treating physician.

If you disagree with the third-opinion doctor, you may ask for an MPN Independent Medical Review (MPN

IMR). The MPN Contact will give you information on requesting an MPN Independent Medical Review

(MPN IMR) and will complete the “MPN Contact section” of an MPN IMR application form for you at the

time you select a third-opinion physician.

If either the second or third-opinion doctor or MPN Independent Medical Reviewer agrees with your need

for a treatment or test, you may be allowed to receive that medical service from a provider within the MPN,

or if the MPN does not contain a physician who can provide the recommended treatment, you may choose

a physician outside the MPN within a reasonable geographic area.

● What if I am already being treated for a work-related injury before the MPN begins?

Your employer has a “Transfer of Care” policy which will determine if you can continue being temporarily

treated for an existing work-related injury by a physician outside of the MPN before your care is transferred

into the MPN.

If your current doctor is not or does not become a member of the MPN, then you may be required to see

a MPN physician. However, if you have properly predesignated a primary treating physician, you cannot

be transferred into the MPN. (If you have questions about predesignation, ask your supervisor.)

County of Orange – County of Orange MPN

If your employer decides to transfer you into the MPN, you and your primary treating physician must receive

a letter notifying you of the transfer.

If you meet certain conditions, you may qualify to continue treating with a non-MPN physician for up to a

year before you are transferred into the MPN. The qualifying conditions to postpone the transfer of your

care into the MPN are set forth in the box below.

You can disagree with your employer’s decision to transfer your care into the MPN. If you don’t want to

be transferred into the MPN, ask your primary treating physician for a medical report on whether you have

one of the four conditions stated above to qualify for a postponement of your transfer into the MPN.

Your primary treating physician has 20 days from the date of your request to give you a copy of his/her

report on your condition. If your primary treating physician does not give you the report within 20 days of

your request, the employer can transfer your care into the MPN and you will be required to use an MPN

physician.

You will need to give a copy of the report to your employer if you wish to postpone the transfer of your

care. If you or your employer disagrees with your doctor’s report on your condition, you or your employer

can dispute it. See the complete Transfer of Care policy for more details on the dispute resolution process.

For a copy of the Transfer of Care policy, in English or Spanish, ask your MPN Contact.

● What if I am being treated by a MPN doctor who decides to leave the MPN?

Your employer or its claims administrator has a written “Continuity of Care” policy that will determine

whether you can temporarily continue treatment for an existing work injury with your doctor if your doctor is

no longer participating in the MPN.

If your employer or its claims administrator decides that you do not qualify to continue your care with the

non-MPN provider, you and your primary treating physician must receive a letter notifying you of this

decision.

If you meet certain conditions, you may qualify to continue treating with this doctor for up to a year before

you must choose a MPN physician. These conditions are set forth in the “Can I Continue Being Treated

By My Doctor?” box above.

You can disagree with your employer’s or its claims administrator’s decision to deny you Continuity of Care

with the terminated MPN provider. If you want to continue treating with the terminated doctor, ask your

primary treating physician for a medical report on whether you have one of the four conditions stated in

the box above to see if you qualify to continue treating with your current doctor temporarily.

Can I Continue Being Treated By My Doctor?

You may qualify for continuing treatment with your non-

MPN provider (through transfer of care or

continuity of care) for up to a year if your injury or illness meets any of the following conditions:

● (Acute) The treatment for your injury or illness will be completed in less than 90 days;

● (Serious or Chronic) Your injury or illness is one that is serious and continues for at least 90

days without full cure or worsens and requires ongoing treatment. You may be allowed to be

treated by your current treating doctor for up to one year, until a safe transfer of care can be

made;

● (Terminal) You have an incurable illness or irreversible condition that is likely to cause death

within one year or less;

● (Pending Surgery) You already have a surgery or other procedure that has been authorized by

your employer or its claims administrator that will occur within 180 days of the MPN effective date,

or the termination of contract date between the MPN and your doctor.

County of Orange – County of Orange MPN

Your primary treating physician has 20 days from the date of your request to give you a copy of his/her

medical report on your condition. If your primary treating physician does not give you the report within 20

days of your request, your employer’s or its claims administrator’s decision to deny you Continuity of Care

with your doctor who is no longer participating in the MPN will apply, and you will be required to choose a

MPN physician.

You will need to give a copy of the report to your employer if you wish to postpone the selection of another

MPN doctor for your continued treatment. If you or your employer disagrees with your doctor’s report on

your condition, you or your employer can dispute it. See the complete Continuity of Care policy for more

details on the dispute resolution process.

For a copy of the Continuity of Care policy, in English or Spanish, ask your MPN Contact.

● What if I have questions or need help?

● MPN Contact: You may always contact the MPN Contact if you have questions about the use of

the MPN and to address any complaints regarding the MPN.

● Medical Access Assistants: You may contact the Medical Access Assistant if you need help

finding MPN physicians and scheduling and confirming appointments.

● Division of Workers’ Compensation (DWC): If you have any questions regarding your rights

and responsibilities under the California workers’ compensation law, you can call the DWC’s

Information and Assistance (I&A) Unit at 1-800-736-7401 for a recorded message or access its

webpage https://www.dir.ca.gov/dwc/IandA.html

to locate the contact information of your nearest

local I&A office for assistance. You can also go to the DWC’s website at www.dir.ca.gov/dwc and

click on “medical provider networks” for more information about MPNs.

● MPN Independent Medical Review: If you have questions about the MPN Independent Medical

Review process, contact the Division of Workers’ Compensation’s Medical Unit at:

DWC Medical Unit

P.O. Box 71010

Oakland, CA 94612

(510) 286-3700 or (800) 794-6900

Keep this information in case you have a work-related injury or illness.