The division shall develop a list of doctors licensed in this state who are approved to provide health care services under this subtitle. A doctor is eligible to be included on the division's list of approved doctors if the doctor: (1) registers with the division in the manner prescribed by commissioner rules; and (2) complies with the requirements adopted by the commissioner under this section.(Tex. Lab. Code § 408.023(a))
Note: This list is not the ADL, which expired 08/31/2007. TDI maintains an online listing of doctors licensed to practice in Texas through the TXCOMP Provider system. This listing can be used by injured employees to select treating doctors and other system participants to verify the status of providers. http://www.tdi.state.tx.us/wc/hcprovider/documents/healthcare9107.pdf
A Service Area means a geographic area within which health care services from network providers are available and accessible to employees who live within that geographic area. (Tex. Ins. Code § 1305.004(24))
Each network shall provide that network services are sufficiently accessible and available as necessary to ensure that the distance from any point in the network's service area to a point of service by a treating doctor or general hospital is not greater than: (1) 30 miles in non-rural areas; and (2) 60 miles in rural areas. (e) Each network shall provide that network services are sufficiently accessible and available as necessary to ensure that the distance from any point in the network's service area to a point of service by a specialist or specialty hospital is not greater than: (1) 75 miles in non-rural areas; and (2) 75 miles in rural areas. (28 TAC § 10.80(d)-(e))
(c) An employee who is dissatisfied with an alternate treating doctor must obtain authorization from the network to select any subsequent treating doctor. The network shall establish procedures and criteria to be used in authorizing an employee to select subsequent treating doctors. The criteria must include, at a minimum, whether: (1) treatment by the current treating doctor is medically inappropriate; (2) the employee is receiving appropriate medical care to reach maximum medical improvement or medical care in compliance with the network's treatment guidelines; and (3) a conflict exists between the employee and the current treating doctor to the extent that the doctor-patient relationship is jeopardized or impaired.
(d) Denial of a request for any subsequent treating doctor is subject to the appeal process for a complaint filed under Subchapter I.
(e) For purposes of this section, the following do not constitute the selection of an alternate or any subsequent treating doctor: (1) a referral made by the treating doctor, including a referral for a second or subsequent opinion; (2) the selection of a treating doctor because the original treating doctor: (A) dies; (B) retires; or (C) leaves the network; or (3) a change of treating doctor required because of a change of address by the employee to a location outside the service area distance requirements, as described by Section 1305.302(g). (f) A network shall provide that an injured employee with a chronic, life-threatening injury or chronic pain related to a compensable injury may apply to the network's medical director to use a non-primary care physician specialist that is in the network as the injured employee's treating doctor. (Tex. Ins. Code 1305.104(b)-(f)
Per previous discussions with TX regulators, the state has advised that if a panel posting is used, it must list all treating doctors (the network is required to identify the specialties that are treating doctors) in the approved service area.
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.