In 2012 the Washington State Legislature passed a law requiring the formation of a medical provider network for treatment of injured workers. As a result, beginning on January 1, 2013, most treatment received for a work-place injury must be done by a provider who is in this approved network.
The network is a list of doctors and other health-care providers that L&I has approved to care for injured workers in Washington State. The network providers meet standards similair to those used by most other health insurance companies in our state.
Starting January 1, 2013, only those providers that are in the L&I medical network can provide ongoing care and get paid for treating your work related injury or condition.
If your doctor or health care provider doesn’t plan to join the network, you must find a new provider for ongoing care after December 31,2012. If you are unsure if your doctor is in the network you can check their status at www.findadoc.lni.wa.gov.
Contact your docotr or health-care provider right away and encourage them to join. If your doctor doesn’t plan to join the network, ask for a referral, or look for a new provider listed on L&I’s approved provider list at www.findadoc.lni.wa.gov. Contact any new doctor to see if they are a provider and to make sure they are accepting patients. Right now there are not enough doctors on the approved list.
Once you have found a new provider, request a transfer of care:
In writing, using the form available online at L&I, or from your doctor or local L&I office.
You must use a network provider whenever you need care from any of these specialities.
Effective January 1, 2013, the following types of providers must be in the network to treat injured workers:
Other types of providers, (not listed above) do not need to join the network at this time. Providers that do NOT need to join include, physical therapists, massage therapists, occupational therapists; pharmacies; and hospitals; out of state providers and others.
If your doctor is not in the network, L&I will not pay them for treating you the injured worker. If they don’t get paid, they will drop your case.
For your protection, your doctor should not bill you for medical treatment allowed for your claim. Your are not obligated to pay for these services; you should call your claim manager if you receive a bill.
This is change. Change is difficult. Add that to the fact that most doctors don’t like the L&I paperwork and other L&I complications. As a result, many of them “are not accepting L&I patients”, or “don’t know what is going on.”
Now, this new provider network requires additional L&I paperwork for the doctor. Guess what, the doctors don’t like this – some are refusing to join – others are delaying.