SEDGWICK PROVIDER NETWORK RULES for TX
Texas Healthcare Network (TX HCN)
Texas HB7 allows for the provision of a Certified Healthcare Network plan. In order for an employee to be deemed participating in the HCN, the employer must have provided all employees a copy of HCN Employee notification packet.
HCN Employee Notification: Employee notification documents are to be given to the employee at enrollment and again at the time of injury. New employees must receive these documents within 3 days of hire.

Provider Selection
Unless covered by the TX HCN, the employee is entitled to initial choice of treating doctor.

TX HCN: Unless the employee has predesignated a provider, or requires emergency medical attention, the employee must choose a provider from the list of HCN providers within the employees General Service Area (GSA).

TX HCN Predesignation: If the employer provides HMO coverage for group health, the employee may notify the employer in writing prior to the date of injury that they wish to be treated by a primary care physician who has previously directed medical treatment for the employee. The provider must have communicated to the HCN their agreement to abide by the rules and regulations of the HCN prior to the injury.

Provider Lists/Panels
A provider list and directory may be utilized.
TX HCN: Provider postings are permitted, and the employee may request access to the providers within his/her GSA.
Non-Sub Clients: For non-subscriber programs, panels may be created.

Additional Regulation
Non HCN: In the event of an emergency or when selected by the employer/insurer, the initial choice of doctor is not considered to be the employee's choice, unless treatment continues for more than 60 days.
TX HCN: In the event of an emergency the employee may choose any provider, but must transfer to an HCN provider upon discharge.
TX HCN: Under the HCN, the employee can be held financially responsible for unauthorized care.