24.29.2311    SELECTION OF MANAGED CARE ORGANIZATION AND TREATING PHYSICIAN WITHIN A MANAGED CARE ORGANIZATION

(1) An injured worker has the right to choose a MCO if the insurer has contracted with more than one MCO in the worker's community, from a list of certified MCOs provided by the insurer. The injured worker has 7 days to select a MCO from the date the insurer gives the worker written notice that the worker must choose a MCO. If the injured worker does not select a MCO within that time, the insurer may select a MCO for the injured worker.

(2) The MCO will designate a treating physician for the injured worker in accordance with the plan, taking into consideration the nature of the injury and the injured worker's preference of treating physician. Within 7 days after the injured worker's initial visit to a medical provider within a MCO as directed by the insurer, the worker may select a personal doctor as the worker's treating physician, provided the personal doctor agrees to comply with all the rules, terms, and conditions regarding services performed by the MCO. The injured worker will be responsible for co-payments if the injured worker is treated by a personal doctor pursuant to this rule.

(3) If the injured worker indicates the desire to be treated by a personal doctor, the insurer has the responsibility of contacting the personal doctor to see if the doctor will comply with the MCO rules, terms, and conditions. The insurer has the responsibility to monitor the personal doctor's compliance with the rules, terms and conditions of the MCO. The insurer may contract with the MCO to perform some or all of these functions.

(4) Once an injured worker has entered a MCO and a treating physician has been designated or a personal doctor has been selected pursuant to this rule as the treating physician, the injured worker may not change either the MCO or treating physician without approval from the insurer.

History: Sec. 39-71-203, 39-71-1103 and 39-71-1105 MCA; IMP, Sec. 39-71-1103 and 39-71-1105 MCA; NEW, 1994 MAR p. 420, Eff. 3/1/94.