Recently a provider shared a letter, apparently meant to intimidate, that it received from a Liberty Mutual Network Specialist, Peter Spalding. The letter threatened to kick the provider out of the Medical Provider Network (MPN) because the provider “pursued lien litigation with the Workers’ Compensation Board.”
As punishment for simply exercising its right to pursue correct reimbursement, the letter from the “Specialist” states that the provider jeopardized its access to the following MPNs:
According to this ultimatum, unless the provider falls in line with the protocol established by Liberty to dispute incorrect payments, all of the injured workers currently treating with this provider would lose access to continuity of care.
Costco, Home Depot, and all employers covered by Liberty Mutual or the Helmsman group: this letter demonstrates how injured workers’ access to care is undermined by procedures put in place by a single claims administrator.
Employers, this is not a sound strategy for quickly returning injured workers to employment. Instead, it appears that injured workers are being used as pawns to force providers to acquiesce and “behave.”
The Liberty Mutual ultimatum states: “Our MPN Protocols expressly state that “disputes must be handled through the dispute-resolution outlined in the network contract. MPN providers should never submit bills on a lien basis.” Denying this provider access to the WCAB is both provider abuse and MPN abuse.
In California there are 459 MPNs approved by the Division of Workers’ Comp. Imagine the chaos for providers if each MPN establishes its own particular “protocol” to dispute incorrect payments, which would doubtlessly deviate from the rules and regulations of the state of California.
As we’ve written about extensively, the California Division of Workers’ Compensation set up the current one-sided appeals process to protect the interests of payors (see this post on Second Review appeals and this post on Independent Bill Review). Nonetheless, this system establishes that a timely lien filed with the WCAB is appropriate when a dispute is not related to the amount of payment as allowed by the Official Medical Fee Schedule.
For a claims administrator to rely on the power of the employer MPN to substitute its own appeals protocols further undermines an already compromised payment system.
It is past time to carefully analyze the role that workers’ comp insurers and third party administrators play in driving workers’ comp costs up. As shown by this latest example of claims administrator “quality outcome” control, they do so in part by denying access to care and by banishing good providers from the workers’ comp system with proprietary punitive payment protocols enforced with ultimatums and threats.
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