Medical Management Services
SeaBright's innovative, multifaceted medical management services and top-notch provider networks have helped reduce claims costs through their aggregate benefits. Services include:
SeaBright Provider Networks:
- National PPO Network: We provide access to quality medical care at discounted rates for workers who use providers in our national PPO network.
- BrightCure® Medical Provider Network (MPN): In California and Texas, policyholders have access to our BrightCure medical provider network (MPN) at discounted rates. In California, we hand-select doctors and facilities based on their ability to meet strict performance standards and metrics.
- Preferential Access Network (PAN): For complex claims involving specialized medical care, injured workers receive preferential treatment that helps return them to health and productivity more quickly. Orthopedists, neurologists, surgeons, and other PAN specialists commit to providing appointments within three to five working days, surgeries within 10 days, and IME/med-legal examinations within 30 days.
BrightCure PDQ®: SeaBright pioneered the practice of physician-guided care for workers' compensation claims. Through our BrightCure PDQ program, we assign a physician to any claim that could potentially involve six weeks or more of lost work time, as determined by predictive modeling. SeaBright physicians have full authority to oversee the claim during its entire lifecycle, including the medical treatment received by injured workers. The program also makes physicians available, as needed, for oversight of less complex claims, and assigns pharmacists or physicians to review all narcotics prescriptions.
Field Case Management Nurses: On select cases, we employ field case management nurses to help monitor and guide an injured worker's medical treatment. Supported by local physicians, field nurses help ensure that injured workers recover completely and return to work as quickly as possible through effective treatment.
Utilization Reviews: To eliminate unnecessary treatments and reduce medical costs, we use physicians, rather than nurses or laypeople, to conduct utilization reviews (URs). Physicians get involved early on to evaluate the medical treatment plan and work with the treating physician to match the right treatment to the injury. All UR data is tied electronically to our bill review system to lower claims costs by preventing payment of disallowed services.
Medical Bill Reviews: Trained staff review every medical bill to guard against over-billing and unnecessary charges.
Pharmacy Benefit Program: To lower prescription costs and avoid out-of-pocket expenses, injured workers can obtain injury-related medications at discounted prices from a network of over 64,000 pharmacies nationwide. Affiliate pharmacies also review prescriptions prior to their being filled and cross-check patient information to identify any potential adverse effects. In addition, health care providers receive SeaBright's experience-based formulary of effective drugs for various worker-related injuries, with an emphasis on lower-cost generic equivalents as appropriate. Beyond this, staff pharmacists provide an extra level of expertise by reviewing narcotics requests, guiding treating physicians in weaning recovering workers of chronic narcotics use, and serving as an ongoing resource for our claims examiners.
Medical Savings Report: Each policyholder can get a summary report documenting the claim costs saved through our medical bill reviews and PPO network discounts.