What Is an MPN?

An MPN is a network of physicians and specialists established by an employer or insurer, to which covered workers are restricted. The idea is to control costs and ensure prompt access to necessary care.

When an employer or their insurer maintains an MPN, generally an injured worker must seek treatment within that MPN. This can introduce friction and headaches for both providers and injured workers.

Specific requirements regarding the makeup of MPNs and treatment access standards come from California Labor Code Section 4616.

How do MPNs Work?

In theory, an injured worker reports an injury and their employer/insurer directs them to an MPN physician for treatment. The worker may select a doctor from the MPN roster.

The treating physician manages care and refers, when necessary, to in-network specialists.

Medical Access Assistants (MAAs) must be available to help workers find doctors and schedule appointments. Within the MPN, a worker may seek second and third opinions if they desire.

Under California Code of Regulations Section 9767.5, every MPN must have at least 2 primary treating physicians within 15 miles or 30 minutes of the workers’ home or workplace, and specialists within 30 miles or 60 minutes.

Crucially, workers may predesignate a personal physician before an injury to bypass the requirement to seek treatment within the MPN. Workers may also seek care outside the MPN if it lacks the required providers.

So What’s Wrong With MPNs?

The above may seem reasonable in theory. In reality, it’s a circus.

First, MPN provider directories are often inaccessible or non-functioning. While § 4616 requires every MPN to maintain a publicly accessible website with provider rosters, updated quarterly and with MAA contact information, this is often not the case.

For an example, see our article on Marriott’s MPN, which is listed under the name of one of its vendors, whose MPN website URL redirects to its parent company, and which requires a username and password to access. Good luck finding care!

Second, the California Division of Workers’ Compensation (CA DWC)’s online MPN list is unreliable, at best. Quarterly updates often cause the entire page to go blank for days or weeks. When it is available, the list comprises thousands of terminated, suspended, or otherwise defunct MPNs, many with names bearing no discernible connection to any employer or insurer.

Bottom line: it can be anywhere from difficult to literally impossible for:

• An injured worker to figure out where they can seek care
• A provider to determine whether or not they’re a member of the correct MPN

How Do MPNs Affect Providers?

Payers know that the MPN system is barely governed, functionally unnavigable, and chaotic.

With no reliable way to verify when an MPN applies or which providers participate, payers deny reimbursement by claiming non-membership in MPNs, or justify discounts by citing membership in MPNs. In either case, the MPN in question is often un-cited, inapplicable, or non-existent.

For examples, see our articles on Gallagher Bassett’s bogus payment denial or Orange County and Sedgwick’s MPN shenanigans.

How Do MPNs Affect Employers?

California employers pay exceptionally high workers’ comp premium rates. For all that money, the system produces exceptionally long claim durations (twice the length of the national median) and exceptionally high administrative costs to deliver benefits (twice the price of the national median).

Those premium dollars fund, among other inefficiencies, the MPN system.

Because the MPN system erects so many barriers to treatment, injured workers feel forced to hire attorneys, further exacerbating claim costs. The longer these battles drag on, the longer workers collect disability payments and stay out of work.

Meanwhile, MPNs give providers yet another reason to avoid treating injured workers, driving them out of the comp system and further eroding access to care.

Why Doesn’t CA Fix the MPN Problem?

The CA DWC has the authority to investigate complaints about MPNs, conduct audits, suspend or revoke MPN approval, and assign penalties. The agency almost never exercises this authority.

MPNs that fail to meet access standards face no meaningful consequences. daisyNews has documented MPN violations and CA DWC inaction repeatedly. We’ve even directly petitioned the CA DWC to revoke approval for a specific non-compliant MPN, all to the tune of crickets.

Until the CA DWC enforces MPN standards, employers will continue to fund a system that fails injured workers, providers, and employers.

daisyBill tracks every bill and payment, with automated task prompts to keep your team on top of it all. Click below to learn more:

LEARN MORE: DAISYBILL