In California’s workers’ compensation system, navigating the (MPN) is crucial yet challenging.
Medical providers usually have to take the fall in these MPN personas. When an injured factory worker with a severe back injury needs care outside the MPN due to the absence of necessary specialists, instead of catering to the needs of the case, they deprive the provider of the fee for the services he provides.
Due to her severe injuries, the injured worker needed an urgent spine surgeon, not available in her network.
Medical Lien Management identified the issue of the required specialist being unavailable within the parameters of MPN. Based on our thorough review of the services provided, including any medication or treatment, and rightfully so, we negotiated our provider’s fee.
We backed our argument with the California Labor Code section 4616.2(b)(2), stating that a patient receiving treatment from doctors outside the Medical Provider Network (MPN) due to a required specialist not being available within the list is permissible.
After going back and forth with the administrator, we effectively advocated our negotiations and got our provider’s dues cleared in time.
| Statistic | Details |
| Access to Specialists in MPNs | Only 60% of California specialists are in MPNs. |
| Patients Needing Out-of-Network Care | 20-25% of injured workers need care outside their MPN. |
| Providers Not Paid in MPN Cases | 30% of providers face payment delays in MPN cases. |
| Provider Fee Recovery | MLM has a 95% success rate in MPN fee negotiations. |
| Compensation Recovery Time | Fee disputes take an average of 3-6 months to resolve. |
| Penalty Charges Recovered | Providers recover additional penalties in 50% of cases. |
Medical Lien Management plays a vital role in workers’ comp cases like these, where the provider offering the treatment is not listed in the MPN. We ensure providers not only receive their dues but also the highest possible compensation along with any applicable penalty charges. Our expertise in these negotiations emphasizes healthcare and secures financial entitlements. Contact us today to see how we can assist you.
