(A) An employee of an employer that participates in a QHP has freedom of choice of providers within the QHP network of providers established by the employer's QHP. In all claims that precede the establishment of the employer's QHP, and where the employee's physician of record is not a provider on a panel of the QHP when established, the employee may continue treatment with that physician of record. The physician of record shall be subject to and participate in the dispute resolution process as provided in rule 4123-6-69 of the Administrative Code. After the establishment of the QHP, the employer's QHP shall manage the medical care and treatment in the claim. If an injured worker changes from the physician of record who is not in the QHP for any reason, the employee shall select a QHP panel provider as the physician of record.
(B) An employee of an employer that participates in a QHP, who is dissatisfied with the health-care services of a provider in the QHP, after written notice to the QHP, may change providers and select another provider of the employee's choice within the QHP. An employee's notice for change of provider within a QHP does not require notification to the bureau. To provide the employer's QHP with data necessary for QHP tracking of employee choice of provider and to provide the bureau with data necessary for recertification of providers, an employee's notice for a change of provider within a QHP shall be in a writing that contains the reasons therefore.
(C) An employee who first has chosen and received health-care services from a provider in the employer's QHP, but is dissatisfied with the health-care services provided by the employer's QHP, may request and shall be granted a change of provider to a bureau-certified provider. An employee's notice for a change of provider to a bureau-certified provider in the QHP shall be in a writing to both the employer's QHP and to the administrator of the bureau.
(1) The bureau shall provide all QHPs with a list of bureau-certified providers in the employees' area. The QHP shall provide an employee with a list of bureau-certified providers upon request. The bureau shall provide an employee, upon request to the bureau, with a list of bureau-certified providers within the employee's area.
(2) An employee who first has chosen and received health-care services from a provider in the employer's QHP, and who has requested and has been granted a change of provider to a bureau-certified provider in the HPP, shall submit a written request to the QHP medically managing the treatment and shall be granted approval to change providers within the HPP. An employee's request for change of provider within the HPP does not require notification to the bureau of the request. An employee who has requested and has been granted a change of provider from an employer's QHP to a bureau-certified provider in the HPP shall be permitted to return to the employer's QHP at any time for health-care services.
(3) Notwithstanding the provisions contained in paragraph (C)(2) of this rule, an employee who incurs a new medical condition, injury or claim requiring medical treatment, not related to a prior medical condition, injury or claim, shall first seek treatment from a provider on the panel of the injured worker's employer's QHP.
(4) To provide the employer's QHP with data necessary for QHP tracking of employee choice of provider and to provide the bureau with data necessary for recertification of providers, an employee's request for a change of provider from a QHP to a bureau-certified provider in the HPP, or a change of provider within the HPP, shall state a reason for the request.
(D) Medical management of all injured workers' claims, whether medical services are provided within or without the QHP network of providers, shall be provided by the employer's QHP.