Below are the Nevada workers’ compensation requirements for physician choice.
Physician Choice - Non-Managed Care Organization (Non-MCO)
Physician Choice - Managed Care Organization (MCO)
Unauthorized Physician Choice - Payment Denied
Exception - Limited Panel Availability
Who Can Treat Injured Workers
Nevada Revised Statutes § 616C.090 - Selection of physician or chiropractic physician: Establishment, maintenance and update of panel of physicians and chiropractic physicians; powers and duties of Administrator; selection and alternate selection from established panel or pursuant to contract; responsibility for charges not in compliance with provisions or related to improper treatments; procedure for removing from panel physicians and chiropractic physicians who do not treat injured employees.
1. The Administrator shall establish, maintain and update not less frequently than annually on or before July 1 of each year, a panel of physicians and chiropractic physicians who have demonstrated special competence and interest in industrial health to treat injured employees under chapters 616A to 616D, inclusive, or chapter 617 of NRS. The Administrator shall maintain the following information relating to each physician and chiropractic physician on the panel:
(a) The name of the physician or chiropractic physician.
(b) The title or degree of the physician or chiropractic physician.
(c) The legal name of the practice of the physician or chiropractic physician and the name under which the practice does business.
(d) The street address of the location of every office of the physician or chiropractic physician.
(e) The telephone number of every office of the physician or chiropractic physician.
(f) Every discipline and specialization practiced by the physician or chiropractic physician.
(g) Every condition and part of the body which the physician or chiropractic physician will treat.
Physician Choice - Non-Managed Care Organization (Non-MCO)
Nevada Revised Statutes § 616C.090 - Selection of physician or chiropractic physician: Establishment, maintenance and update of panel of physicians and chiropractic physicians; powers and duties of Administrator; selection and alternate selection from established panel or pursuant to contract; responsibility for charges not in compliance with provisions or related to improper treatments; procedure for removing from panel physicians and chiropractic physicians who do not treat injured employees.
2. Every employer whose insurer has not entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527 shall maintain a list of those physicians and chiropractic physicians on the panel who are reasonably accessible to his or her employees.
3. Except as otherwise provided in NRS 616C.091, an injured employee whose employer’s insurer has not entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527 may choose a treating physician or chiropractic physician from the panel of physicians and chiropractic physicians.
Physician Change - Non-MCO
If the injured employee is not satisfied with the first physician or chiropractic physician he or she so chooses, the injured employee may make an alternative choice of physician or chiropractic physician from the panel if the choice is made within 90 days after his or her injury.
The insurer shall notify the first physician or chiropractic physician in writing. The notice must be postmarked within 3 working days after the insurer receives knowledge of the change. The first physician or chiropractic physician must be reimbursed only for the services the physician or chiropractic physician, as applicable, rendered to the injured employee up to and including the date of notification.
Except as otherwise provided in this subsection, any further change is subject to the approval of the insurer or by order of a hearing officer or appeals officer.
A request for a change of physician or chiropractic physician must be granted or denied within 10 days after a written request for such a change is received from the injured employee. If the insurer takes no action on the request within 10 days, the request shall be deemed granted.
Any request for a change of physician or chiropractic physician must include the name of the new physician or chiropractic physician chosen by the injured employee.
If the treating physician or chiropractic physician refers the injured employee to a specialist for treatment, the insurer shall provide to the injured employee a list that includes the name of each physician or chiropractic physician with that specialization who is on the panel. Not later than 14 days after receiving the list, the injured employee shall select a physician or chiropractic physician from the list.
Physician Choice - Managed Care Organization (MCO)
Nevada Revised Statutes § 616C.090 - Selection of physician or chiropractic physician: Establishment, maintenance and update of panel of physicians and chiropractic physicians; powers and duties of Administrator; selection and alternate selection from established panel or pursuant to contract; responsibility for charges not in compliance with provisions or related to improper treatments; procedure for removing from panel physicians and chiropractic physicians who do not treat injured employees.
4. Except as otherwise provided in NRS 616C.091, an injured employee whose employer’s insurer has entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527 must choose a treating physician or chiropractic physician pursuant to the terms of that contract.
If the injured employee is not satisfied with the first physician or chiropractic physician he or she so chooses, the injured employee may make an alternative choice of physician or chiropractic physician pursuant to the terms of the contract without the approval of the insurer if the choice is made within 90 days after his or her injury.
Except as otherwise provided in this subsection, any further change is subject to the approval of the insurer or by order of a hearing officer or appeals officer. A request for a change of physician or chiropractic physician must be granted or denied within 10 days after a written request for such a change is received from the injured employee. If the insurer takes no action on the request within 10 days, the request shall be deemed granted.
If the injured employee, after choosing a treating physician or chiropractic physician, moves to a county which is not served by the organization for managed care or providers of health care named in the contract and the insurer determines that it is impractical for the injured employee to continue treatment with the physician or chiropractic physician, the injured employee must choose a treating physician or chiropractic physician who has agreed to the terms of that contract unless the insurer authorizes the injured employee to choose another physician or chiropractic physician.
If the treating physician or chiropractic physician refers the injured employee to a specialist for treatment, the insurer shall provide to the injured employee a list that includes the name of each physician or chiropractic physician with that specialization who is available pursuant to the terms of the contract with the organization for managed care or with providers of health care pursuant to NRS 616B.527, as appropriate. Not later than 14 days after receiving the list, the injured employee shall select a physician or chiropractic physician from the list. If the employee fails to select a physician or chiropractic physician, the insurer may select a physician or chiropractic physician with that specialization. If a physician or chiropractic physician with that specialization is not available pursuant to the terms of the contract, the organization for managed care or the provider of health care may select a physician or chiropractic physician with that specialization.
Physician Change - MCO
5. If the injured employee is not satisfied with the physician or chiropractic physician selected by himself or herself or by the insurer, the organization for managed care or the provider of health care pursuant to subsection 4, the injured employee may make an alternative choice of physician or chiropractic physician pursuant to the terms of the contract. A change in the treating physician or chiropractic physician may be made at any time but is subject to the approval of the insurer or by order of a hearing officer or appeals officer.
A request for a change of physician or chiropractic physician must be granted or denied within 10 days after a written request for such a change is received from the injured employee.
If no action is taken on the request within 10 days, the request shall be deemed granted. Any request for a change of physician or chiropractic physician must include the name of the new physician or chiropractic physician chosen by the injured employee.
If the insurer denies a request for a change in the treating physician or chiropractic physician under this subsection, the insurer must include in a written notice of denial to the injured employee the specific reason for the denial of the request.
Unauthorized Physician Choice - Payment Denied
6. Except when emergency medical care is required and except as otherwise provided in NRS 616C.055, the insurer is not responsible for any charges for medical treatment or other accident benefits furnished or ordered by any physician, chiropractic physician or other person selected by the injured employee in disregard of the provisions of this section or for any compensation for any aggravation of the injured employee’s injury attributable to improper treatments by such physician, chiropractic physician or other person.
Exception - Limited Panel Availability
Nevada Revised Statutes § 616C.091 - Selection of physician or chiropractic physician: Injured employee choice of physician to treat certain occupational diseases under certain circumstances; payment for treatment; reimbursement of payment; penalty for failure to reimburse within required time.
1. If an injured employee has filed a claim pursuant to NRS 617.455 or 617.457 and, at the time the claim is filed, the panel of physicians or chiropractic physicians maintained by the Administrator pursuant to NRS 616C.090 contains fewer than 12 physicians or chiropractic physicians in a discipline or specialization appropriate for the treatment of or the provision of other services relating to the occupational disease of the injured employee who are accepting new patients and are available to meet with the injured employee within 30 days after the date on which the injured employee first contacts the physician or chiropractic physician to request an appointment, the injured employee may seek treatment or other services related to the occupational disease of the injured employee from a physician or chiropractic physician of his or her choice selected in accordance with subsection 2.
2. An injured employee may select a physician or chiropractic physician of his or her choice pursuant to subsection 1 from a list of all physicians or chiropractic physicians in the relevant discipline or specialization who have entered into a contract with an organization for managed care, under a health benefit plan or otherwise with a health insurer or casualty insurer of the employer of the injured employee, whether or not the physician or chiropractic physician has specifically contracted to provide treatment or other services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS, or has been previously approved pursuant to NRS 616B.527.
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