As daisyNews frequently explains, California's Medical Provider Network (MPN) system accomplishes nothing other than making treatment less accessible for injured workers and turning revenue management into a nightmare for providers.

California employers are forced to fund this MPN dysfunction by purchasing comp coverage from insurers like The Hartford.

The Hartford recently granted authorization to a provider for psychotherapy, but attempted to make that authorization conditional on the provider's MPN membership, a sketchy hedge against reimbursement with no support in California law or regulations.

The Hartford provided an MPN name, but no MPN ID number, despite maintaining multiple MPNs. As it happened, the provider is a member of the applicable MPN. Yet The Hartford denied reimbursement anyway, claiming on its Explanation of Review (EOR) that:

"THE TREATING DOCTOR AND/OR SERVICES RENDERED WERE NOT APPROVED…”

Now the provider must navigate California's lengthy, costly, and payer-friendly bill dispute process to pursue their rightful reimbursement.

This payment denial is a textbook example of how the MPN system helps drive providers out of the comp system entirely. When payers can leverage (and arguably exploit) MPNs to deny reimbursement for authorized treatment, doctors stop accepting comp patients.

Today’s story is a warning to providers to carefully consider whether it’s worth the hassle to treat workers covered by The Hartford. As the debacle below (and an additional story we’ll explore in tomorrow’s article) demonstrates, this insurer exemplifies what pushes providers out of the system.

Unlike providers, most employers have no option to tap out of workers’ comp; they must continue to pay ever-increasing premiums, along with disability payments for injured employees who struggle to find care in a system that deters provider participation.