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Texas Workers Compensation - New Certified Networks

 


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New workers comp laws in Texas have some healthcare professionals changing the way they practice medicine and the injured workers are caught in the middle.

Early in 2006, the Texas Workers Comp legislation made extreme changes from their past operational methods. Certified networks have been established, affording better discounts for employers and insurance carriers.

Healthcare professionals in Texas have major decisions to make as far as how they are going to run their practices. Many have opted out of workers comp altogether, while others are attempting to be a part of these networks, only to be turned away with the statement “our panel is full".

In researching these provider databases posted by the Networks/Carriers, we have found many descrepancies in providers that are listed, but are not taking work comp cases, or in some cases, it appears that company doctors or company owned medical centers, make up the majority of the healthcare panel, offered to patients and employers. It hardly seems fair, that consumers and injured workers are forced to go to providers that are not of their choosing.

New workers comp laws in Texas have some healthcare professionals changing the way they practice medicine and the injured workers are caught in the middle.

In many states there is an “any willing provider" law that allow any healthcare professional that is willing to take the insurance carrier discounts, may participate in any insurance plan without fail. Unfortunately, Texas is not one of those states.

Providers in most cases are at the mercy of these networks. Many times, former patients try to come in for care only to find that their carrier/network has not allowed their provider to be included for whatever reason. this has been very disturbing to many patients that we have spoken to. In some cases, patients may speak to their HR department or write letters to their insurance carriers, asking for their chosen provider to be allowed in their network. In some cases with some carriers, this may work.

Some healthcare specialties, chiropractors in particular, are forced to apply for network participation through outside entities to even be included in the panels with major carriers. Once again, these providers fight and struggle to be a part of these networks and are not allowed to participate due to the old statement “our panel is full".

In this day and age of consumer rights, it seems to the author, that all providers should be allowed to participate in which ever network they choose to participate in if they meet the state criteria for participation and are willing to accept the discounts offered by these carrier/networks. Providers are loosing patients on a daily basis and loosing money that is necessary to continue to offer affordable healthcare to their patients. We have even found in our research where some medical doctors are even going back to “cash" practices because they are so disillusioned with the healthcare systems we are force to accept.

As a consumer or injured worker, the only answer to make sure you get to see the provider you wish to have treat you is to stand up and speak out to your legislators, employers and your congressmen.

Michele Graham-CEO and owner of Professional Healthcare Management has 43 years in the healthcare industry. She writes about business issues in all businesses and the healthcare field as well.

http://www.phmnetwork.com

http://www.texasphysiciansnetwork.com

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