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Workers’ Compensation PPP’s

We’ve had questions come to our office about the new Workers’ Compensation PPP’s (Preferred Provider Programs). Under the new Work Comp law passed this May, employers are allowed to establish PPPs’ of medical providers that have been approved by the Department of Insurance. We’ve had a number of doctors ask us what we thought of network X, or if they should join network Y, but these are questions that, due to anti-trust laws, we cannot speak on. We need to ensure that we do not steer our doctor’s opinions when it comes to prices or networks, but we might be able to answer many of your questions by giving non-specific information on PPP’s and their structure.

Employees will be notified of any established program on an official form promulgated by the Illinois Workers’ Compensation Commission (IWCC). The PPP only applies to cases in which the PPP was already approved and in place at the time of the injury. If at the time of the injury the employer did not have an approved PPP, then the employee gets their standard two choices of physicians. If the PPP was in place, then employees have two choices of treating providers from within that PPP. However, if the Commission finds that the second choice of physician within the network has not provided adequate treatment, the employee may choose a physician from outside the network.

Even if your employer has an approved PPP, the employee may opt out in writing but doing so limits them to only one choice of outside physician. If an employee chooses non-emergency treatment prior to the report of an injury, that will constitute as a choice of physician. Regardless, employees may still see any provider who one of their choices refers them to (chain of referral).

No PPP’s have been approved yet. The following release was put out by the IWCC on July 18, 2011:

PPP approval process under construction

The Department of Insurance is establishing a process by which payers may gain approval to function as a Preferred Provider Program (PPP) in workers’ compensation. Approval as a PPO for health care is not the same as approval as a PPP for workers’ compensation. We are in consultation with IDOI. Once IDOI establishes its program, we will post the form with which an employer may notify an injured worker of its PPP.

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Categories: Uncategorized

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