Medical Provider Network Q&A for Workers
Read Q&A for medical providers instead.
What is L&I’s new Medical Provider Network?
The network is a group of doctors and other health-care providers that L&I has approved to care for injured workers in Washington State. Our network providers meet standards similar to those used by most other health insurance companies in our state.-
How does the new network change my medical benefits?
As of January 1, 2013, only those providers that are in the L&I; medical network can provide ongoing care for your work-related injury or condition.
-
Which providers must join the network?
Effective January 1, 2013, the following types of providers must be in the network to treat injured workers:
- Physicians
- Dentists
- Chiropractors
- Advanced registered nurse practitioners
- Naturopathic physicians
- Optometrists
- Podiatric physicians and surgeons
- Physician assistants
If these types of providers aren't in the network, they will not be paid for treating injured workers except for the initial office or emergency room visit when a claim is filed.
-
What about providers that are not required to join the network?
Some providers do not currently need to join the network, including:
- Physical, occupational, and massage therapists.
- Out-of-state providers
You can find network-exempt providers at Lni.wa.gov/FindADoc and you can see them for covered services. Other providers that do not need to join the network include:
- Providers of diagnostic testing, such as interpreting MRIs or CT scans.
- Doctors practicing exclusively in hospitals or emergency rooms.
- Facilities such as pharmacies and hospitals.
- All providers not explicitly required to join the network.
-
How can I check my provider's network status?
Check at Lni.wa.gov/FindADoc. New providers join the network every week.
-
What if I want to be treated by my regular doctor for a work-related injury, but they're not in the network?
You can see an out-of-network provider only for the initial office or emergency room visit.
For additional care, you must transfer to a network provider. Encourage your doctor to enroll in the network.
- What should I do if my provider is not in the network?
Contact your doctor or health-care provider right away and encourage them to join.
- What if my provider doesn't plan to join?
If your doctor or health-care provider doesn't plan to join the network, you must find a new provider for ongoing care. Ask your current provider for a referral. Or look for a new provider at Lni.wa.gov/FindADoc. Contact new providers to make sure they are accepting patients.
-
I found a new provider who is willing to take on my care. What else do I need to do?
If your claim is managed by You should L&I Request a transfer of care, once you have found a new provider. There are 2 ways to do this:
- Online at Lni.wa.gov/TransferCare.
- In writing, by downloading and completing the Case Transfer form. You can also get this form at doctors’ offices and L&I offices.
a self-insured employer Contact your employer directly. Find contact information for self-insured employers. -
I can't find a new provider. Who can I contact for help?
If your claim is managed by You should L&I Call 360-902-6480 or 1-800-547-8367 for help.
a self-insured employer Contact your employer directly. Find contact information for self-insured employers. -
Do I need to use network providers for all of my care?
- You must use a network provider whenever you need care from the types of providers that are required to join the L&I network.
-
Can providers bill me for treating my work-related injury or condition?
No. Providers should not bill you for medical treatment allowed for your claim. You are not obligated to pay for these services, and should call your claim manager if you receive a bill.
Exception: If you miss a scheduled appointment without cancelling, your provider can charge you.
-
What if I see an out-of-network provider for a work-related injury, for example if I'm taken to the hospital, will the services be paid?
For initial treatment when a claim is filed, including hospital admission, you can see an out-of-network provider. For additional care, you must transfer to a network provider.
-
What is the definition of initial visit?
The initial visit to a health-care provider is the appointment when you complete the accident report for filing your workers' compensation claim. We can only pay network providers for treatment other than the initial office or emergency room visit.
- My employer is self-insured. Am I still required to use network providers?
Yes, employees of self-insured companies must be treated by network providers after the initial visit. You will use the same network as workers covered by L&I.
- My provider is just now applying for the network. Can I continue to see them while L&I is reviewing their application?
In some cases you may be able to continue seeing your provider for up to 60 days while their network application is being processed.
Check Lni.wa.gov/FindADoc to see if your provider is listed as a network provider. If not, call us to confirm your provider’s status: 360-902-6480.
-
What if I get ongoing care from an out-of-network doctor after January 1, 2013?
Your benefits could be interrupted unless you have a network provider for ongoing care.
Only network providers can certify your medical condition and whether you are able to work. L&I or your self-insured employer (or a third-party administrator) must have this information in order to pay your benefits.
-
I want to see a new provider 60 miles away. Can I get reimbursed for my travel expenses?
Some of your travel expenses may be reimbursable if:
- No other provider who is qualified to treat your injury is available closer to your home, and
- Your claim manager pre-authorizes the travel.
-
Why was it necessary to create a provider network?
High-quality medical care helps injured workers return to health and their jobs as soon as safely possible. Research shows that health-care providers using best practices for occupational medicine generally have better outcomes with injured workers. The network will encourage the use of the best practices.
The workers' compensation medical network will be made up of providers that meet standards similar to those of other large health carriers in the state. Our goal is for workers to get the broadest possible access to great care, return to good health and get back on the job sooner.
L&I was directed to create the network by the 2011 Legislature.
