Your Exam

  • Summary information

    Your Independent Medical Exam (IME) scheduled through MCN will be different from a visit with your own medical provider. The goal of a standard office visit/examination is to maintain your overall health and usually involves treatment. An IME is an examination based upon claim questions posed by a client who needs to make decisions of a medical nature. Treatment is not offered and the evaluating provider is not at – any point – engaged in a doctor-patient relationship with you.

    You may be evaluated by more than one provider depending on the nature of your injuries or condition. The providers(s) are not employed by or affiliated with the party requesting your evaluation and they are not employees of MCN.

    This evaluation may have been requested by any one of the following: your treating provider, an attorney, a government agency, an insurance company, or by a claims adjuster managing your injury claim. The purposes of the evaluation are to obtain an objective opinion on your injury or disability claim and to answer specific questions by the requesting party.

    This evaluation is not meant to constitute a general medical evaluation and is not a substitute for your seeking any necessary care from your personal provider(s) or other regular health care provider. The objective evaluation results may be summarized in the form of a written report which will be forwarded to the party that requested this evaluation. Please note that the opinions expressed in any and all report are the conclusions of the examining provider(s) and do not reflect the opinions of MCN.

    Your examination with an MCN provider is usually on a one-time basis. You are being examined for the purpose of assisting in the management of your claim, not to receive treatment. With this in mind, the medical professional you are scheduled with does not keep your medical record on file.

    Your examination should meet the highest possible medical standards. MCN also recognizes the importance of reputation and credibility, and carefully credentials providers through external verification of licensure, Board Certification, and regulatory compliance.

    Privacy Policy

    The privacy of your examination and medical information is regulated by federal, state, and local laws. All requests for release of medical records should be referred to MCN or your referring agency for handling as appropriate to the case. The Privacy Act generally prohibits the disclosure of medical information. Visit our privacy policy to learn more about how your privacy and the privacy of your examination and records will be protected by MCN and contracting providers throughout the process.

    Pre-Appointment Preparation

    Before arriving for your examination, you will be contacted by an MCN representative in preparation for the appointment. MCN staff will contact you as needed for more instructions, forms, and/or paperwork. If you have any questions, please contact MCN.

    Re-Scheduling

    If you need to reschedule or cancel the appointment, contact MCN immediately. Please remember that postponement of your appointment may cause a delay in the processing of your case by your referring agency or suspension of any benefits you may be receiving.

    Notification Package

    Depending on the agency’s requirement, you will receive a notification package in the mail with some or all of the following items:

    • Appointment letter confirming your examination date and pertinent information

    • Medical history questionnaire (if applicable)

    • Map to the facility when appropriate

    Post-Appointment

    The examining provider will compile the examination evidence into a medical report. Once completed, the report will be reviewed to verify the content is clear, consistent, and complete. This quality assurance function is strictly administrative in nature and the opinion of the provider is conveyed as expressed and intended by that provider.

    Once the medical report is complete, it is delivered to the referring agency who will make the claims decision.

    If you’d like to find out the status of your medical report and determination, please contact the entity who referred your claim. MCN is solely responsible for conducting the examination and diagnostic tests and submitting the complete medical report to the referring agency. You should never receive any bills from providers or lab facilities relating to your examination. If you have any questions, please contact the MCN office handling your examination.

    Contact

    • Western United States, 888.626.4637

    • Eastern United States, 800.394.4637

    • Southeast United States, 800.331.6269

    • Midwest United States, 866.535.6269

  • Why request an External Review?

    When your health insurance carrier denies a claim for medical care or treatment, they are required by law to provide you with a process to appeal the denial. If you complete your carrier’s internal appeals process and your claim is still denied, your case may be eligible for an External Review (sometimes called "final" or "binding" review). In an External Review, your case will be re-evaluated by specialty reviewers to determine whether the disputed claim should be covered.

    Who can request an External Review?

    You or your authorized representative (including your treating provider) may file a request for an External Review. That request should be filed with either your health insurance carrier or an applicable state agency. Information on how to file is required by federal law to be included with the final claims denial decision from your insurer. External Reviews are conducted by Independent Review Organizations like MCN and are generally assigned on a rotating or random basis to ensure impartial results.

    When MCN is selected as the Independent Review Organization for your case the review will proceed as follows:

    • The insurance carrier is required to send us all of the materials they used to determine your coverage denial.

    • You will also receive instructions on where to supply additional information for consideration in your case.

    • Relevant information may include: your medical records, your treating provider’s recommendations, reports from appropriate health care professionals and other documents submitted by the carrier, you, and/or your treating provider, your health insurance plan text, appropriate practice guidelines, and any applicable clinical review criteria developed and used by your plan.

    • All of your medical documents will be handled in accordance with the strictest federally mandated patient privacy laws.

    Reviewer Selection/ Reviewer Decisions/ Conflict of Interest

    When all supporting documentation has been received, MCN will assign a specialty reviewer to your case. All of our reviewers go through a rigorous credentialing process, following URAC-approved standards, and are then vetted for any potential conflict of interest. The reviewer(s) assigned to your case will be matched based on the specialty of your treating provider and their experience treating the medical condition(s) in question.

    In addition to any received documents, the specialty reviewer will use their expertise and additional reference materials at their discretion to make a decision.

    Our reviewers are not bound by any of the decisions or conclusions made by the health insurer during the internal appeals process and will review all the elements of your case from scratch.

    What happens next?

    After your External Review is complete, both you and your health insurance carrier will receive written notice of our specialty reviewer’s decision.

    External Review decisions are legally binding.

    However, we and our specialty reviewers cannot be held liable in any way for the outcome of your review. If our specialty reviewer determines that your benefit denial should be overturned, your health insurance carrier is responsible for authorizing coverage or payment for the claim. If our specialty reviewer upholds the benefit denial you may still have the right to pursue a judicial review of your case.

    Other resources to help you

    If you have any further questions about your rights or need assistance, you can contact the Employee Benefits Security Administration (EBSA) at 866.444.3272 or the Center for Consumer Information and Insurance Oversight (CCIIO) at 877.696.6775.

  • Who to Contact

    If you are already scheduled for an Independent Medical Examination with one of MCN’s examiners and need to reschedule or cancel your appointment, please contact the entity who arranged for your examination.

    You may also reach us at the following numbers:

    • Western United States: 206.622.8128

    • Eastern United States: 631.454.8522

    • Southeast United States: 813.908.6700

    • Midwest United States: 630.620.4550

    • National Operations Office: 206.621.9097

    Not sure who to contact? All MCN offices are fully integrated electronically, so any of our team members nationwide will be able to take your call and provide assistance.