FAQ: Does SIF provide a list of 'preferred' medical providers?

The State Insurance Fund does not maintain a list of “preferred” medical providers. However, we do encourage employers to choose a designated (or preferred) medical provider/facility that understands the employer’s business and will work with the employer, the injured employee, and the insurance company in providing quality medical care, as well as coordinating return-to-work efforts.

In Idaho, the employer has the option of designating a medical physician to treat employees when they are injured on the job. Usually, the selection of a designated provider begins by talking to medical facilities that have an occupational medicine program. Selecting a designated provider might involve interviewing the coordinator of the occupational medicine program to find out how the facility operates (what are their hours of operation and what type of physicians are on staff), what medical services they offer (office visits, diagnostic tests, etc.), and discussing the types of injuries that commonly occur in their business to see if the facility has the medical staff available to handle those types of injuries. It is important the physicians involved have an understanding of the workers compensation law and their role in managing work related injuries. This would include managing the medical treatment, determining light duty restrictions, and relaying any permanent restrictions once an injured worker’s condition is stable.

In recent years, the selection process has become easier because a variety of occupational health programs have been developed and are marketed by hospitals and physician associations. The occupational health programs are offered to businesses as a way to better manage on-the-job injuries by providing better communication between the employer, medical provider, insurance company and employee. Services may include immediate reporting of medical findings to the employer and the insurance company, attention to the employer's individual job requirements in order to coordinate early return-to-work opportunities, 24-hour medical access, multiple facility locations, and educational services. One of the best places to start the search for an occupational health provider could be as close as your phone book.

Selecting a designated provider does not result in LESS employer responsibility. On the contrary, the employer may find he or she is MORE involved in the work comp process. The benefit of this greater involvement typically results in a better understanding of how the system works and what management can do to not only control costs, but prevent injuries. To implement a designated provider program, the employer must select a facility that is open 24 hours a day, or notify employees where they should go during the hours when the facility is closed. The alternate location may be a hospital that would be accessible at all hours of the day. In addition, the designated provider/facility must be able to see an injured employee in a timely manner so treatment can be started.

Although some provider groups offer medical services in cities throughout a region, if a business has work locations statewide, it may be necessary to select more than one provider in order to have services available for all employees.

There are some important steps to consider when setting up your program:

• For a designated provider program to be successful, it must apply to all employees on a consistent basis. Exceptions to seeing a designated provider may occur when an employee has an injury which requires treatment outside the designated provider’s area of expertise, such as a dental or eye injury. Some businesses make their programs "voluntary" and find that most employees still participate.

• Be sure that every employee is notified of the new procedure. Hold meetings. Prepare a policy regarding what to do in the event of an on-the-job injury and have that policy posted. You may also want to include the policy in the employee handbook or procedures manual. Have employees sign an acknowledgment form that they have been advised of the procedure and understand it.

• Make it easy for employees to know where and when they can find needed medical attention. You may want to post a map with the location(s) of the designated provider(s) and their hours of operation, phone numbers, etc. (Ask your medical provider for posters with this information.)

• Periodically ask employees if they are satisfied with the care received from the provider/facility. If there are complaints, discuss them with the designated provider/facility to clear up any issues.

If a designated medical provider is selected, notify the Claims Department at the State Insurance Fund by either calling or submitting a completed Designated Medical Provider form . This information will help the claims examiner know who to expect bills and medical reports from.

Implementing a designated provider program does not necessarily mean employees will accept the program. The program must be perceived as beneficial for everyone involved to be successful. A designated provider program can be more than just a partnership between the employer and doctor. Handled correctly, the employer, employee, medical provider and insurance company will all come out ahead by making medical care more immediately available when an employee is injured, improving communication between all parties and speeding up decisions regarding medical treatment.