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Montana Compliance



Physician Selection 39-71-1101 MCA

The employee has the initial choice except that an insurer contracting with a Managed Care Organization (MCO) can direct the employee to the MCO for medical care.

Also, insurers will be able to direct the employee to preferred provider organizations (PPOs) in addition to, or in conjunction with, managed care organizations. After the date the insurer gives the employee written notice of a preferred provider, the insurer is no longer liable for charges if the employee continues to see the nonpreferred provider. If the employee continues to receive treatment from a nonpreferred provider, the employee, rather than the insurer, is responsible for paying for that treatment.

Prior authorization from the insurer is required for the following:

  • a change of physician, or
  • any treatment after the employee has reached maximum medical improvement (MMI), or
  • when there has been no treatment for 6 months, or
  • for specialized medical care.