Overview of a medical
An MPN is a network of providers that has been certified by the State
of California Division of Workers Compensation to provide health care
to injured workers. The MPN has been certified by the State, and The First
Health Network providers are an integral part of the certified MPN. The
FirstHealth Network has met specific access and health care delivery standards
for providers in the MPN.
Cast & Crew, through its insurance carrier, uses FirstHealth, a national
managed-care company, whose network has been approved by the state under
your employers MPN. For any questions relating to the MPN, compensability,
benefits, continuity of care plan or transfer of care plans, please contact
your employer or local claim office. To report an injury, contact your
You may pre-designate your physician(s) prior to injury using the attached
form if (1) you have received care with the physician and (2) the physician
agrees to be your primary treating physician. If your physician does not
agree to participate in this capacity, you will be required to seek care
with an MPN provider.
Treatment for work-related injury
In an emergency, go to the nearest emergency medical center and notify
your supervisor as soon as possible. For non-emergency situations, you
may use either your pre-designated physician or contact Cast & Crew
to locate a provider. The MPN has primary treating providers available
within 15 miles or 30 minutes or specialty care within 30 miles or 60
minutes from your work or residence. If you have difficulty in scheduling
an appointment or need any assistance in locating a provider, contact
Cast & Crew, claims professional or nurse case manager. Should you
sustain an injury while traveling, go to the nearest occupational health
clinic or emergency facility. Notify Cast & Crew as soon as you return
from traveling in order to obtain a referral to an MPN provider. If you
need a specialist, your primary treating physician, claims professional
or nurse case manager can locate a provider within the FirstHealth MPN.
Existing workers compensation claims
If you have a pending claim, contact your clame handler. You may qualify
to continue treatment with your current provider under your employers
transfer of care plan if your condition is acute, serious or chronic,
or if treatment is for remission, to prevent deterioration, a terminal
illness or for a scheduled surgery or procedure that will occur within
Obtaining prior authorization for
Your treating physician must obtain prior authorization for services by
contacting your local claims office. The designated claims office will
review your physician's treatment plan and render a recommendation. You,
your claims professional and physician will receive a copy of the review
Appeal of non-certifications
If your treatment is non-certified, you may request an appeal by following
the appeal instructions that were attached to the non-certification notice.
You may change physicians within the MPN as long as the provider is qualified
to treat your injury. Your claims professional, nurse case manager or
Cast & Crew can provide MPN provider names. If you require additional
services beyond the initial visit, you may use any provider, appropriate
to your injury, within the MPN.
Second and third opinions
If you dispute the diagnosis or treatment prescribed by your treating
physician, you may request two additional opinions from other MPN physicians.
To file a dispute, you must submit the objection in writing to the insurance
carrier within 20 days of receipt of the decision in dispute. Your employer
will set up a medical evaluation with a mutually acceptable MPN physician.
If you dispute the third physician s opinion, you may contact the California
Department of Workers Compensation at 415-703-4600 for an independent
Terminated MPN providers and continuity
If your physician terminates from the MPN, your employer will advise you
on your options for continued treatment as approved under your employer's
continuity of care plan. In some instances, the terminated physician may
continue to treat you through your employers continuity of care plan.
Copies of it are available upon request. Contact Cast & Crew or your
local claims office for questions or advice on your options.
If you have further questions, please contact:
Cast & Crew Workers' Compensation Department - (818) 848-6022