MASSACHUSETTS
Employee Selects
Except for the employee's first scheduled appointment, which, pursuant to the terms of a preferred provider arrangement entered into may be required to be with a health care provider within the plan, the employee may select a treating health care professional other than any provided or agreed to by the insurer and may switch to another such professional once. (ALM GL ch. 152 § 30)
Change of Provider
Except for the employee's first scheduled appointment, which, pursuant to the terms of a preferred provider arrangement entered into may be required to be with a health care provider within the plan, the employee may select a treating health care professional other than any provided or agreed to by the insurer and may switch to another such professional once. When referred by the treating health care professional to another provider in a particular specialty, the employee may also change once to a different provider in such specialty. (ALM GL ch. 152 § 30)
Panels
Not addressed
Panel Provisions
See direction of care law.
MASSACHUSETTS PPA
Employee Selects from Network
Except for the employee's first scheduled appointment, which, pursuant to the terms of a preferred provider arrangement entered into under this section may be required to be with a health care provider within the plan, the employee may select a treating health care professional other than any provided or agreed to by the insurer and may switch to another such professional once. (ALM GL ch. 152 § 30)
Employees subject to any arrangement shall be provided information regarding their rights and obligations upon initial approval of the PPA and annually thereafter. Such information shall also be posted in a prominent place in all worksites:
The list of names of the providers in the PPA within an employee's geographic region or of all health care providers within the arrangement organized geographically shall be distributed to each covered employee immediately following an alleged workplace injury. The names on such lists shall be arranged in order of medical specialty or provider type. A current list shall also be posted at a convenient and prominent place for covered persons to examine at worksites, and shall be given to any covered person upon request. (452 CMR 6.03)
If a covered person receives emergency care and cannot reasonably reach a preferred provider, payment for care related to the emergency shall be made at the same level and in the same manner as if the covered person had been treated by a preferred provider; provided, however, that every brochure, contract, policy manual and all printed materials shall clearly state that covered persons shall have the option of calling the local pre-hospital emergency medical service system by dialing the emergency telephone access number 911, or its local equivalent, whenever a covered person is confronted with a need for emergency care, and no covered person shall in any way be discouraged from using the local pre-hospital emergency medical service system, the 911 telephone number, or the local equivalent, or be denied coverage for medical and transportation expenses incurred as a result of such use of emergency care; (ALM GL Ch. 176I § 3)
Change of Provider
Except for the employee's first scheduled appointment, which, pursuant to the terms of a preferred provider arrangement entered into under this section may be required to be with a health care provider within the plan, the employee may select a treating health care professional other than any provided or agreed to by the insurer and may switch to another such professional once. When referred by the treating health care professional to another provider in a particular specialty, the employee may also change once to a different provider in such specialty. (ALM GL ch. 152 § 30)
Panels
Not addressed
Panel Provisions
See Direction of Care law for employee notification requirements.The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.