About 4COMP Network
2003 reform legislation, Senate Bill 2013, established that the former West Virginia Workers’ Compensation Commission MUST approve any managed care plan before an employer or workers’ compensation carrier can require its injured workers to use health care providers designated by the plan. With the additional passage of SB 1004 in 2005, workers’ compensation managed health care plans and Preferred Provider Organizations (PPOs) are now to be approved by the Offices of the Insurance Commissioner effective January 1, 2006. Essentially, Senate Bills 2013 & 1004 introduced managed care into the workers compensation system…
The State of West Virginia is slowly transitioning from a state-run monopoly administered by the former West Virginia Workers’ Compensation Commission to a “privatized” market; starting with the first private employers’ mutual entity, BrickStreet Mutual Insurance Company. BrickStreet essentially grew from the former state-run system and will enjoy the position of being the sole provider of workers’ compensation coverage in West Virginia until July 2008, when the market opens to all private carriers and thus true competition.
However, starting July 2004, all operational self-insured plans received the legal authority to self-administer such plans. West Virginia historically allowed self-insurance but left administrative judgments to the state and the former Workers’ Compensation Commission. Now with true self-administration, the responsibility falls on the plan to determine if a claim is covered, if benefits are due and if medical services are appropriate, the selection & implementation of PPOs, plus a multitude of other concerns.
Under the “Rule”, employers must identify a “reasonable choice of providers” for injured workers. Workers who suffer a work-related injury or occupational disease cannot be required to pay co-payments or deductible for medical services.
Injured workers can “opt-out” of the employer’s plan/PPO; (1) for emergency care when access to a health care provider within the plan/PPO is unobtainable, (2) when authorized treatment is unavailable throughout the plan/PPO or (3) to obtain a second opinion when a plan/PPO physician recommends surgery and another qualified physician within the plan/PPO is not available for consultation.
Employers must designate adequate specialty and subspecialty providers, as well as general and specialty hospitals, according to “convenient geographic accessibility” for all categories of licensed care. The “Rule” states, primary care within 75 driving miles of the employer’s facility is considered geographically reasonable.
The Managed Care Plan/PPO “must be owned and operated by an organization or entity sufficiently unrelated and independent of the employer in terms of ownership and control.
4COMP Network has been developed from a subset of workers’ compensation treating providers already participating in 4MOST Health Network, one of the leading West Virginia PPOs.
Current plans call for a nucleus of more than 600 primary care locations. Each of these locations will work with select specialists needed to treat clients’ injured workers.
Gary C. Shorter, Jr., Vice President, Business Development, addressed the prospect of 4COMP entering the West Virginia Workers’ Compensation market, saying “it is good to see that employers may now focus on what treatments and providers are actually effective in getting their employees back to work.”
4COMP Network is a new tool for conscientious employers looking to get their workers’ compensation provider access and costs under control, while offering quality care to their employees.
For more information, please call:
Gary C. Shorter, Jr.
Vice President, Business Development
888-258-6477 x203
gshorter@4most.com
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