Medical Benefits
Medical benefits are paid, including all doctor, hospital, and treatment bills, as well as prescriptions, appliances, and any other devices recommended by the doctor for the care and treatment of the injury that are reasonable and necessary to cure or relieve the effects of the injury. The employee is not required to pay any co-pays. There are treatment parameters and fee schedules that govern these services and also the payment for them. The statute allows reimbursement of mileage expenses (58.5 cents per mile) for traveling to and from the doctor, hospital, or other medical care provider (such as physical therapy).
Managed Care
An employer may require the employee to receive treatment and supplies from a Managed Care Plan. MINN. STAT. § 176.135(1)(f) (2006). If the employee requests a change of treating provider they must use those available under the Plan. MINN. R. 5218.0200, SUBP. 5B (2006).
Dispute Resolution On Issues Related To Managed Care
Managed Care Plans may provide for an initial method of dispute resolution. An employee must exhaust the dispute resolution procedure prior to filing a Medical Request or Claim Petition on issues of medical treatment.
Treatment By Providers Not In The Managed Care Plan
Minnesota Rule 5218.0500, subpart 1 states that a health care provider who is not a participating health care provider may provide treatment to an employee covered by a Managed Care Plan in any of the following instances:
- If the treatment is with a health care provider who has a documented history of treatment with the employee before the date of injury (whether for a work-related condition or not).
- In an emergency.
- When the employee is referred to the provider by the Managed Care Plan.
- When the employee is receiving treatment for a claimed injury from a nonparticipating provider where liability for the injury is admitted or established later than 14 days after the employer received notice of the injury.
In order for a nonparticipating provider to treat an employee under the Managed Care Plan, the health care provider must agree to comply with the Managed Care Plan treatment standards, utilization review, peer review, dispute resolution, and billing and reporting procedures. In addition, the nonparticipating provider must agree to refer the employee to the Managed Care Plan for specialized services including, without limitation, physical therapy and diagnostic testing, except for minor diagnostic testing that may be done in the nonparticipating provider’s office. MINN. R. 5218.0500, SUBP. 2 (2006).
