LAW
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Ohio Laws and Rules
(A) An injured employee may seek medical care for an industrial injury from
(1) A bureau certified provider
(2) An MCO panel provider; or
(3) A non-bureau certified provider, subject to an employee’s payment responsibilities as delineated in rule 4123-6-12 of the Administrative Code.
(B) At the time of an injury, the employee may seek medical care directly from A provider or may seek assistance from the MCO. If the employee has not already sought medical care or selected a provider, the MCO may refer the employee to a provider. The MCO shall ask if the employee has any preference as to specialty of provider and shall make any referrals accordingly. The MCO shall not discriminate against any category of health care provider when referring the employee to a provider. The employee may, but is not required to, seek medical care from the referred provider.
(C) If the employee seeks medical assistance from a provider, the employee shall inform the provider of the employee’s MCO. The provider shall then notify the MCO of the contact by the employee. If the provider is a bureau certified provider, the provider must agree to provide treatment pursuant to the MCO’s guidelines. If the provider is a non-bureau certified provider, the provider will be informed by the MCO that the care for the first visit will be compensated by the MCO if the claim and the treated conditions are subsequently allowed. The MCO will inform the non-bureau certified provider that no further treatment will be authorized.
(D) An injured employee may continue treatment with a non-bureau certified provider under two circumstances:
(1) The provider may apply to the MCO for emergency credentialing as necessary for care and services which are unavailable through like MCO panel providers, or
(2) The employee may continue to treat with a non-bureau certified provider, but at the employee’s own expense without recourse against the MCO, employer, or bureau.
R.C. 119.032 review dates: 10/27/2004 and 03/01/2009
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 2/16/96, 1/1/01