What in the name of comp are the County of Orange and Third-Party Administrator (TPA) Sedgwick up to?

As reported previously, Sedgwick insists Orange County will refuse to pay for authorized treatment delivered via telehealth, and that it is entitled to do so. When pressed for details, a Sedgwick representative stated:

1. Every provider in Orange County’s Medical Provider Network (MPN) was notified to “cease and desist” all virtual appointments for Orange County employees. Sedgwick could not furnish proof of said notification.
2. The prohibition on telehealth is not included in authorization forms because such information “isn’t a required element on the authorization forms.”

According to Sedgwick’s logic, each of the 2,505 MPNs listed by the Division of Workers’ Compensation (DWC) may establish arbitrary treatment restrictions that participating providers are “expected to adhere to,” fee schedules be damned.

Of course, providers have no reliable way to determine which, if any, of the 2,505 MPN applies to a given injured worker—let alone whether the MPN asserts its own random treatment rules.

Moreover, Sedgwick claimed that the applicable MPN was “the Wellcomp MPN.” And according to the WellComp MPN website, telehealth is allowed and encouraged.

Sedgwick: “Every MPN provider” Knows Telehealth Not Allowed

Sedgwick could not provide any documentation that providers were notified of Orange County’s telehealth ban, but “believed” every provider in Orange County’s MPN was told “at some point” over the last 18 months to “cease and desist all virtual appointments.”

Since California does not provide a way for practices to determine the appropriate MPN for injured workers, the practice requested the name and ID number of the MPN Sedgwick referenced.

Sedgwick responded with the ominous (and suggestive) sound of crickets. The following day, the practice followed up, essentially having to plead with Sedgwick to identify the MPN that Orange County uses to deny telehealth treatment to its employees.

Finally, though Sedgwick couldn’t (or wouldn’t) produce an MPN ID number, the representative informed the practice that Orange County “is registered with the Wellcomp MPN.”

WellComp MPN Allows Telehealth

Putting aside the fact that California’s Physician Fee Schedule unquestionably allows telehealth care, Sedgwick’s suggestion that Orange County’s “no telehealth” rule is an MPN policy contradicts the material on the WellComp MPN website.

Under its ‘Resources’ tab, the site offers access to WellComp’s stated “Tele-Health Policy.”

Clicking the link opens a PDF (below) outlining WellComp’s approach to telehealth, stating (emphasis ours):

With the goal of ensuring appropriate, quality medical care, administered in a timely fashion, in compliance with California Labor Code Section 4616.2 and as well the Title 8 California Code of Regulations (CCR) Section 9767.10; the Medical Provider Network offers the covered employee Telehealth, a/k/a Telemedicine as an optional service under the MPN.

The WellComp MPN document even cites the specific sections of the California Labor Code and Code of Regulations with which its policy of allowing telehealth treatment complies.

So we’re clear, according to Sedgwick:

• MPNs may impose employer-specific treatment guidelines on providers who have no reliable way of knowing which MPN — if any — applies.
• These employer-specific treatment guidelines are not divulged when treatment is formally authorized.
• Orange County established a policy of refusing to pay for approved treatment when delivered via telehealth.
• Every provider in Orange County’s Medical Provider Network (MPN) was notified to “cease and desist” all virtual appointments for Orange County employees.
• Orange County’s MPN is WellComp.

…yet WellComp’s publicly available policy is to allow telehealth treatment.

Providers treating Orange County employees, take note. Sedgwick’s claims are preposterous — as is the state of chaos California’s legislators and regulators have allowed to persist in workers’ comp.

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