What If MPN is NOT EQUIPT ?

[inquiringMIND]

QUESTION FROM CALI

Current PTP is an Occupational Medicine MD.

Due to my orthopedic,neuro issues, I've requested to switch my PTP to an Orthopedic physician but getting some resistance and wasn't sure why until a recent discussion with a Nurse Case Manager.

I was told that if I needed to see a specialist (ortho, neuro etc.) I could be referred by the Occupational Medicine doc.

She went on to explain that the MPN ortho/neuro specialists were good at diagnosing and treating my particular problems but because they were not knowledgeble/aware of workers comp laws, the paper work, benefits etc, an ortho or neuro could not act as my PTP.

SMH...

If the MPN is not equipt to offer orthopedic drs. who can act as a PTP would this be grounds for the WC board to approve care outside the MPN?

Hmmm.....

[1171]

I think the carrier would like to know what the NCM is telling you and then decide what they would like to do.
The NCM may not be speaking for the carrier or have shared their opinion with them.
if you are not represented, you might discuss your issue with directly with the carrier.

[chrischris]

The problem I see here is that most orthopedic doctors do not want to act as the primary treating physician. However, if you find an orthopedic treating doctor in your MPN, you can ask if they will act as your PTP. By doing so they must comply with the requirements of being your PTP. This means more paperwork.

An injured worker can only have one PTP, but can have as many treating physicians as needed who all report your progress to your PTP.

An occupational medical doctor is a very good choice to have as a PTP, if you have complex injuries requiring different specialties to treat you. He/she is the "gatekeeper" of your claim and will make referrals as medically necessary, to your claims examiner. You can choose any treating doctor within your MPN, if the specialty is appropriate to your injury. It is a good idea to have a "name" ready for your PTP so when the referral is made, a specific doctor can be asked for.

[inquiringMIND]

UPDATE.

After making a request in writing to switch my PTP to an Ortho within the MPN, my adjuster gave his consent after much discussion and apparent reluctance on his part..smh.

1171~ The adjuster agreed with the Nurse Case Manager (see earlier post) on the specialists (ortho, neuro company doctors) not knowing workers comp laws, benefits, paperwork etc. and that yes, I was better off having an OCC MED COMPANY DOC as my PTP.

I declined.

Now I'm waitng for my adjuster to send all my doctors reports to the new orthopedic doctor I've chosen within the MPN but is NOT A COMPANY DOCTOR.

Question: Is it best to have ONE PTP for two separate claims? What are the pros and cons?

As always, thank you so much for your feedback.

[1171]

it depends on the situation. generally a single person overseeing multiple treatment programs can avoid conflicts in medication, diagnostics and overall care.
there is no one answer for every patient but treating the whole patient rather then part is often preferable.

[inquiringMIND]

1171~ i appreciate the idea of being treated as a "WHOLE PERSON" rather than spare parts....lol!!!

thanks.

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1171~ i appreciate the idea of being treated as a "WHOLE PERSON" rather than spare parts....lol!!!

thanks.

[Woodlawn]

(01-10-2012 07:47 PM)inquiringMIND Wrote:  UPDATE.

After making a request in writing to switch my PTP to an Ortho within the MPN, my adjuster gave his consent after much discussion and apparent reluctance on his part..smh.

1171~ The adjuster agreed with the Nurse Case Manager (see earlier post) on the specialists (ortho, neuro company doctors) not knowing workers comp laws, benefits, paperwork etc. and that yes, I was better off having an OCC MED COMPANY DOC as my PTP.

I declined.

Now I'm waitng for my adjuster to send all my doctors reports to the new orthopedic doctor I've chosen within the MPN but is NOT A COMPANY DOCTOR.

Question: Is it best to have ONE PTP for two separate claims? What are the pros and cons?

As always, thank you so much for your feedback.

There are plenty of orthopedists who are familiar with work comp laws. After all, most work comp injuries are orthopedic in nature. I believe the NCM mistaken at best. Assuming your employer is not self insured, you do not need the adjuster's consent to switch doctors in the MPN. If you are not represented, a decent working relationship with the adjuster usually helps.

It is generally better for the patient to have 2 PTP. Depending on the injuries though, it may not be the case. There are joint orthos, spine orthos, hand orthos, etc. While they may generally be qualified, most will punt to the appropriate subspecialty.