Acting as your impartial advisor — coordinating care and facilitating communication between the injured worker, the employer, the health care provider, and any other involved parties.
In an emergency, injured employees should go directly to the nearest New Hampshire emergency room, and follow up with the nurse case manager after the evaluation.
Members should always contact Nurse Case Manager Marta Silakka immediately after an injury occurs so that she can help the injured employee access the most appropriate network provider. Call Marta at NHADA at 800-852-3372.
The nurse case manager will then assist the injured employee to choose the appropriate provider for the treatment of the injury/illness.
Not all emergency physicians are familiar with our specific network, protocols, and procedures. If an emergency room physician refers the injured employee to a specific doctor, they should verify that the physician is part of the The Windham Group network before making the appointment in order to avoid being held responsible for that bill.
In 1990 the State of New Hampshire began a pilot program on Managed Care due to the rising cost of medical care and indemnity payments of Workers' Compensation insurance coverage. The pilot was a voluntary program involving three counties in the state. The program was conducted for three years, and the results showed a drastic reduction in both lost time and medical costs. The success of the pilot program led to the legislation of Managed Care law for all counties in New Hampshire by 1994.
"Lab 704.01 Employers.
(a) An employer selecting the managed care option to fulfill its obligations under RSA 281-A:23 shall:
(1) Inform all employees that it is participating in a managed care program;
(2) Provide each employee with necessary information on how to access the network when he or she suffers a work-related injury or illness;
(3) Notify the insurer, third party administrator, managed care organization, and department of labor of all injuries to employees; and
(4) Cooperate with the insurer and managed care organization in providing temporary alternative duty programs and reinstatement of injured employees in accordance with Lab 504.04 and 504.05."
"Lab 704.03 Employees.
(a) An employee who received medical, hospital or remedial care under a workers' compensation managed care program shall:
(1) Have the right to choose a physician or other health care provider from the network, and to make one change of physician or health care provider within the network at each level of treatment;
(2) Have the right to privacy during examinations conducted by a health care provider;
(3) Have the right to obtain a copy of the protocols established by the managed care organization;
(4) Have the right to treatment outside the network in accordance with the provisions of Lab 703.01 (o);
(5) Have the right to request a second opinion relative to diagnosis or course of treatment in accordance with Lab 703.01 (o);
(6) Have the right to request an independent medical opinion in accordance with Lab 705.01;
(7) Have the right to subsequent independent medical opinions, as provided in RSA 281-A:38-a;
(8) Have the obligation to accept treatment within the health care provider network, if the services are provided therein; and
(9) Have the obligation to cooperate with the managed care organization, insurer and employer with respect to temporary alternative duty assignments and reinstatement to employment as provided in Lab 504.04 and 504.05."