By Donna Motley, Vice President of Claims

Our office will periodically receive telephone calls from insureds with questions concerning the occupational clinic they utilize, i.e. where should they send employees, does MTMIC have to approve the clinic, what clinics are near their facility, are some clinics better than others, should bills for service be sent directly to the insured or MTMIC, etc.? Our advice is always the same: an employer should develop a relationship with an occupational clinic that is close to their facility. You should be able to call your clinic and talk “one on one” with the staff – including the physicians. In most cases, they will welcome the opportunity.

MTMIC’s Claims Department reviews all medical records and bills related to work injuries. At the end of last year, a couple of issues arose on a couple of claims that involved 4 Concentra Occupational Clinics. Two cases involved continued treatment without authorization, another involved a physician refusing to comment on “causal relationship” and the last involved Concentra’s billing department changing their mind about a verbal compromise agreement in a litigated case. As I had recently attended a seminar sponsored by Concentra, I was aware of their alleged treatment and procedure philosophies. SO, I contacted the Concentra Medical Director and Concentra Director of Sales. The Medical Director, who is a doctor, called me to discuss the particulars of the cases. We did not necessarily agree on what constitutes proper protocol, but he asked that I follow up our conversation with written proofs. Which I did. (I had also consulted legal counsel to assure I was accurate in my interpretation of the Workers’ Compensation Act on which I based my contentions – and I was.) After going back and forth a couple of times, I am happy to say we have been able to amicably resolve all issues.

A couple of weeks ago, Kimberly Davis and I met with the Concentra Medical Director and the Sales Director to discuss the Workers’ Compensation industry and the roll each of us assume. All parties felt it was a very positive and enlightening meeting. There are 16 Concentra locations in the Metropolitan area and 2 locations in Grand Rapids. I know a vast number of our insureds utilize Concentra’s services. A Concentra advantage – they employ 28 specialty doctors that include Orthopedic Surgery, Hand Surgery, Physical Medicine & Rehabilitation, General Surgery, Neurosurgery, Spine Surgery, Hand Plastic Surgery and Foot & Ankle Orthopedic Surgery. This means we can usually obtain a quicker referral to a specialist. All of the specialty physicians have their own practice and treat outside of Concentra as well. They are not “just a clinic doctor”.

We have also been given a list of each Center Medical Director, Center Therapy Director, Center Operations Director and Center Sales Manager for each Concentra location. We have been encouraged to call any of the Directors at any time to discuss any issue that may arise. They encourage open communication between the employee, employer and insurance carrier. They agreed that employers should invite the clinic doctor to walk through the employer’s facility and look at individual jobs and functions being performed so they better understand an injury and how to treat same.

Overall, Concentra seems earnest in providing quality care and working with employers and employees for a successful outcome in returning the employee to work. What started out as a service complaint resulted in a closer working “partnership”. We will soon be touring a Concentra facility and so can you!