State Codes and Statutes
Statutes > North-carolina > Chapter_97 > GS_97-25_2§97‑25.2. Managed care organizations.
The requirements of G.S. 97‑25may be satisfied by contracting with a managed care organization.Notwithstanding any other provision of this Article, if an employer or carriercontracts with a managed care organization for medical services pursuant tothis Article, those employees who are covered by the contract with the managedcare organization shall receive medical services for a condition for which theemployer has accepted liability or authorized treatment under this Article inthe manner prescribed by the contract and in accordance with the managed careorganization's certificate of authority; provided that the contract complieswith rules adopted by the Commission, consistent with this Article, governingmanaged care organizations. An employee must exhaust all dispute resolutionprocedures of a managed care organization before applying to the Commission forreview of any issue related to medical services compensable under this Article.Once application to the Commission has been made, the employee shall beentitled to an examination by a duly qualified physician or surgeon in the samemanner as provided by G.S. 97‑27.
If an employee's medicalservices are provided through a managed care organization pursuant to thissection, subject to the rules of the managed care organization, the employeeshall select the attending physician from those physicians who are members ofthe managed care organization's panel, and may subsequently change attendingphysicians once within the group of physicians who are members of the managedcare organization's panel without approval from the employer or insurer.Additional changes in the attending physician or any change to a physician orexamination by a physician not a member of the insurer's managed careorganization's panel shall only be made pursuant to the organization's contractor upon reasonable grounds by order of the Commission. (1993(Reg. Sess., 1994), c. 679, s. 2.1.)
