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The Hartford’s Texas Workers’ Compensation Health Care Network

The Hartford's state-certified health care network brings together doctors, hospitals, and medical providers to deliver prompt and appropriate treatment to employees injured on the job.

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The Hartford’s Texas Workers’ Compensation Health Care Network

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  1. The Hartford’sTexas Workers’ Compensation Health Care Network

  2. What is a Health Care Network? • In 2005, Texas enacted the Workers’ Compensation Health Care Network Act. • The Hartford’s state-certified health care network brings together doctors, hospitals and other medical providers to deliver prompt and appropriate treatment to employees injured on the job.

  3. What do I have to do? • Your employer has enrolled in The Hartford’s Health Care Network. • You will be given an enrollment package that describes the network requirements. • This enrollment package includes information about finding a network doctor or other network provider. • There is also a network acknowledgement form that you must read, sign, and return to your employer.

  4. What do I have to do? • You must use doctors and other health care providers that are part of the network. • Exceptions • You do not have to use a network provider if you do not live within the network’s service area… • Or if you are enrolled in an HMO and your HMO doctor agrees to follow The Hartford’s network rules when treating your work-related injury. • You must set this up with your HMO doctor before you are injured at work.

  5. What is a Geographic Service Area (GSA)? • A Geographic Service Area refers to a part of the state where the network operates. • If you live in a GSA, you must use network doctors and health care services. Your residence is determined by the following: • Your principal residence for legal purposes, including the physical address you gave to your employer. • A temporary residence necessitated by employment. • A temporary residence taken by the employee primarily for the purpose of receiving necessary assistance with routine daily activities because of a compensable work-related injury

  6. How do I know if I live within a GSA? • Attachment B provides a map and listing of all counties included within each network GSA.

  7. How do I find a doctor, hospital, or other health care service in my area? • We have an online provider search tool and a Network Referral Unit (NRU). • The online provider search tool is available at www.talispoint.com/htfd/external. • Attachment A explains how to use this website. • The Network Referral Unit can be contacted at 1-800-327-3636 . • Select option 4. • If you do not have Internet access, ask your employer for a listing of network providers.

  8. What if I am Injured? • For an emergency… • In a medical emergency, go to the nearest emergency care facility as quickly as possible. • Tell your employer about your accident as soon as possible. • For a non-emergency… • Tell your employer about your accident • Get an appointment with a network doctor as soon as possible

  9. What’s a “Treating” Doctor? • A treating doctor is your main, or primary, doctor. He or she will be the first doctor you see for an injury that is not an emergency. He or she will direct you to specialists or other health care services as needed. • The treating doctor will also help you with any treatments that require preauthorization from the network. • A preauthorized medical treatment must be approved by the network before the patient receives it. • A list of treatments requiring preauthorization is provided in the employee notification letter.

  10. What if I am dissatisfied with the Network? • If you disagree with a preauthorization decision made by the network, you may appeal the decision to the network. • If you disagree with the appeal decision, you can contact the Texas Department of Insurance to ask for a review by someone outside the network. • Attachment E explains this process. • If you are dissatisfied with some other aspect of the network or a network doctor’s service, you can make a complaint to the network. • Attachment D explains this process.

  11. For Additional Information visit theTexas Department of Insurance website atwww.tdi.state.tx.us/faq/wcnet/wcfaqemployee.html

  12. Questions & Answers

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