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ZENITH HEALTH CARE NETWORKWelcome to the Zenith Health Care Network (ZHCN) – a customized network of physicians, hospitals,outpatient facilities, and ancillary services for the state of Texas. As a policyholder participating in thenetwork, you must provide your employees with copies of the materials listed below in both English andSpanish. The law requires that you develop and document a standardized method for delivery of theNotice of Network Requirements packet to all current and new employees.You must document the following information: 1) Delivery Method (for example: mail, email); 2) ToWhom the Notice was Delivered; and 3) Date(s) of Delivery. Failure to document the delivery can createa presumption that employees didn't receive the Notice of Network Requirements packet and aren'tsubject to participation in the ZHCN.AT ZHCN SIGN UP:Provide the Notice of NetworkRequirements packet to allemployees in English andSpanish, and post it in an areafrequented by employees,including: Service Area Map Acknowledgment Form Pre-Designated PhysicianFormYou must distribute the packet toall employees within 30 days ofsigning up to participate in theZHCN network. These noticesdon't need to be redistributed ifyou are in a renewal year with theZHCN and you distributed them inthe past.AT TIME OF HIRE:Provide the Notice of NetworkRequirements packet to anynew employees in English andSpanish, including: Service Area Map Acknowledgment Form Pre-Designated PhysicianFormYou must distribute the packetto employees within three daysof hiring them. We recommendthat you provide these alongwith other tax and employmentforms.Download a copy of the currentversion of the packet fromZenith Solution Center .AT TIME OF INJURY:Provide the Notice of NetworkRequirements packet to anemployee immediately followingan injury in English and Spanish,including: Service Area Map Acknowledgment Form Pre-Designated PhysicianForm TX Workers’ Comp form(DWC-1)Report employee injuries toZenith at 800-440-5020 within24 hours. Ensure that theinitial medical appointmentis scheduled with the ZHCNtreating doctor within threecalendar days. VisitTheZenith.com to find a list ofproviders in your area.Download a copy of the currentversion of the packet fromZenith Solution Center .Every time you distribute the Notice of Network Requirements, employees must sign and return the Acknowledgement Form to you.Keep the signed form in the employee's personnel file. Refusing to sign the form doesn't void participation in the ZHCN. If an employeerefuses to sign the form, document the date and method of Notice delivery and log it in the employee's personnel file.QUESTIONS? Contact us at 800-440-5020 or txnetwork@thezenith.comZenith Insurance Company/ZNAT Insurance Company Corporate Office 21255 Califa Street, Woodland Hills, CA 91367 2018 Zenith Insurance Company. All rights reserved. Zenith and TheZenith are registered US service marks. WC–TXNONR 0618PAGE 1
Zenith Health Care NetworkHCN License Number: 13041730Zenith Health Care NetworkEmployee Notice of Network RequirementsYour employer provides medical services forwork related injuries through the certifiedZenith Health Care Network (ZHCN). TheZHCN includes doctors, hospitals and othermedical providers in 231 counties which iscalled the ZHCN Service Area.If you are injured at work you must check tosee if you live in the ZHCN Service Area. Ifyou do live in the ZHCN Service Area, youmust receive all health care for your injurythrough the ZHCN.The information in this notice will explain theZHCN Service Area and will help you getmedical care through the ZHCN. If you haveany questions, you can ask your employer, orcall 1-800-841-3987.Claims AdministratorYour claims administrator is:Zenith Insurance CompanyZHCN Service AreaA map of the ZHCN Service Area is attached.If you live in the ZHCN Service Area, youmust pick your Treating Doctor from theZHCN Provider Directory. Your TreatingDoctor will treat you. Your Treating Doctormay refer you to another health care providerfor other medical treatment.If you think you do not live in the ZHCNService Area you may contact your claimsexaminer. You have to request a review inwriting. If you request a review, you have toprovide proof to show that you do not live inthe ZHCN Service Area. Your request forreview should be sent to your claimsadministrator.Contact for Complaints:Zenith Insurance CompanyATTN: Provider RelationsMailing Address:21255 Califa StreetWoodland Hills, CA 91367Your claims administrator will review yourrequest and within seven (7) days of receiptof your request will make a decision and giveyou written notice. If you do not agree withthe decision, you may file a complaint.Complaints should be filed with theDepartment of Insurance (See Complaintssection for more information).Email for Complaints:txnetwork@thezenith.com1Access to Health Care ServicesWhen requested, the ZHCN must arrange formedical services in a timely manner, takinginto consideration your circumstances andmedical condition. This includes referrals tospecialists. In any circumstance, servicesmust be arranged no later than 21 days afterthe date of the request.Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730While your request is under review, you mayseek all medical care within the network. Todo this, you should select a ZHCN TreatingDoctor. All health care for your work injurywill be set up with your Treating Doctor.Emergency CareIf you are injured at any time - and you thinkit is a medical or mental health emergency call 911 or go to the nearest medical facilityoffering emergency care services.If it is determined that you live in the ZHCNService Area, you may have to pay for healthcare if it is from a provider that is not in theZHCN.You may be injured while you are outside ofthe ZHCN Service Area. If this happens andyou think it is a medical or mental healthemergency, go to the nearest medical facilityoffering emergency care services or call 911.How to Get Health Care through the ZHCNTell your supervisor or manager immediatelyif you are injured at work.You should pick your Treating Doctor fromthe ZHCN Provider Directory. You may needa referral to a specialist or other health careprovider. Your ZHCN Treating Doctor mustmake all referrals. If you need emergencycare, you do not have to go through yourZHCN Treating Doctor.ZHCN providers will only treat and bill youremployer’s workers’ compensation insurer orclaims administrator for services related to acompensable work injury. ZHCN providerswill not bill you.You may want to get health care fromproviders who are not in the ZHCN. To dothis, you must first get approval from yourclaims administrator. If you do not getapproval to use providers who are not in theZHCN, you may have to pay for thoseservices yourself.The exceptions to this rule are: Emergency Care If you do not live within the ZHCN ServiceArea Out-of-network care that your claimsadministrator pre-authorized Your HMO Primary Treating Physician isyour Treating Doctor2Zenith Health Care Network (ZHCN)You should contact your claims administratoras soon as possible to report your injury.Texas Law defines the term “medicalemergency” as an acute medical conditionthat occurs suddenly. Symptoms are severeand include severe pain. A patient’s health,bodily function or function of any organ orbody part could be in serious jeopardywithout immediate medical care. The TexasLaw also defines the term “mental healthemergency”. It is a condition that couldreasonably be expected to present danger tothe person experiencing the mental healthcondition or another person.Non- Emergency CareIf you are hurt at work, and it is not anemergency, pick a Treating Doctor from theProvider Directory. The Provider Directory isavailable on your claims administrator’swebsite. You may also call your claimsadministrator for help choosing a TreatingDoctor. Your claims administrator is listedabove.You should call your Treating Doctor to setup an appointment. Your claims administratorcan also help you set up an appointment.You may be injured while you are outside theService Area. If this happens and you neednon-emergency health care please call yourclaimsadministrator.Yourclaimsadministrator will help you locate a medicalprovider.NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730After-Hours CareYou may need after-hours medical care. Ifthis happens, call your claims administrator.Your claims administrator will help you find aprovider or facility. You may also visit yourclaims administrator’s website to select aprovider from the online directory. You shouldcontact your employer to report your injury assoon as possible.If you have a medical emergency, call 911 orgo to the nearest emergency room. After youget treated for your emergency, all follow-upand non-emergency care must be set upthrough your Treating Doctor.Selecting a Treating DoctorYou must pick a Treating Doctor from theProvider Directory. Your Treating Doctormust be located in your Service Area. TheProvider Directory will show which providersare taking new patients. If you would like helppicking a Treating Doctor, please call yourclaims administrator.If you are a member of a Health MaintenanceOrganization (HMO) you may pick yourPrimary Care Physician as your TreatingDoctor. You must have chosen this doctor asyour primary care physician through yourHMO before your work related injuryoccurred and your HMO Primary CarePhysician has to agree to treat your workers’compensation injury. To do this, complete theattached “Physician pre-designation form”.Return the completed form to your employer.If you would like your HMO Primary CarePhysician to treat you for a work injury,please contact your claims administrator.Your claims administrator will review yourrequest and notify you of their decision within72 hours. Your HMO Primary Care Physicianwill not be considered as an initial choice of aTreating Doctor unless this process isfollowed.The following also will not be considered aninitial choice of Treating Doctor:3Zenith Health Care Network (ZHCN) A Doctor who works for your employer;A Doctor providing emergency care; orAny doctor who provided care before theemployee was enrolled in the ZHCN,unless it was your HMO Primary CarePhysician which you pre-designated usingthe process set forth above.You may not be happy with the first TreatingDoctor you picked. If this happens, you canpick an alternate Treating Doctor. Contactyour claims administrator for help picking analternate Treating Doctor. When you pick analternate Treating Doctor, you must providethe name of the Doctor to your claimsadministrator.If you are not happy with the alternateTreating Doctor, you must contact yourclaims administrator to submit a request foradditional changes. They will review yourrequest and give you written notice of theirdecision within seven (7) days.Continuing your Treatment if yourTreating Doctor is Terminated from theNetworkIf your Treating Doctor leaves the Network,you will be notified in writing. If this happens,and you need to continue treatment, youmust pick another Treating Doctor. To dothis, pick a new Treating Doctor from theProvider Directory. If you would like help withthis,callyourclaimsadministrator.You may continue treatment with youroriginal Treating Doctor under certaincircumstances: If you have a life-threatening medicalcondition. Your medical condition is acute and adisruption in care could harm you.If one of these conditions applies to you, yourTreating Doctor has to contact your claimsadministrator and request a review. Yourclaims administrator will review the TreatingDoctor’s request then give you and yourNONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730Doctor written notice of their decision. If youor your Doctor disagrees with your claimsadministrator’s decision, you may file acomplaint (See Complaints section for moreinformation).Services Requiring Pre-AuthorizationAll health care must be set up through yourTreating Doctor. Your Treating Doctor willtreat you. Your Treating Doctor may refer youfor treatment for your work injury. Certainservices must be approved by your claimsadministrator in advance. Services thatrequire preauthorization are listed on theZenith Health Care Network and NonNetworkServicesRequiringPreAuthorization List (“Pre-Authorization List”).A copy is included in this Employee Notice ofNetwork Requirements.To have any of the services requiringpreauthorization approved, your Doctor mustfollow ZHCN preauthorization requirements.You will be given written notice of thedecision. You have a right to request areconsideration of an adverse determination(an adverse determination is when theproposed medical care is determined notmedically necessary). You will receiveinformation with the adverse determinationnotice about how to submit a reconsideration.You also have a right to request a review byan Independent Review Organization if thereconsideration decision on an adversedetermination is upheld. You will be giveninformation about these rights as well. Thereview will be randomly assigned to anIndependent Review Organization by theTexas Department of Insurance. Anemployee with a life-threatening condition isallowed an immediate review by anIndependent Review Organization and is notrequired to comply with the procedures for areconsideration of an adverse determination.of the ZHCN operation. Verbal complaintsand written complaints are accepted.You have 90 days to submit a complaint. The90 day period starts on the date when theproblem or issue first came up. When yourcomplaint has been received, it will bereviewed. A written notice explaining thereview and decision will be sent to you within30 calendar days from the date yourcomplaint is received.Complaints should be directed to your claimsadministrator.You may not be satisfied with how yourcomplaint was handled. If this happens, youhave a right to complain. There is a form touse for your complaint. Your completed formshould be sent to the Texas Department ofInsurance’s Health & Workers’ CompensationNetwork (HWCN) Division.The Department’s complaint form can beobtained from www.tdi.texas.gov or:Texas Department of InsuranceDivision of Workers’ Compensation, MS-87551 Metro Center Drive, Suite 100Austin, TX 78744The completed form should be sent to theaddress indicated on the form.It is not legal for a network to retaliate againstan employee, employer, or medical providerfor filing a complaint. It is not legal for anetwork to retaliate against an employee ormedical provider who appeals a decision ofthe network.*The Zenith Health Care Network is owned and operated by ZenithInsurance Management Services, Inc. acting only in the capacity ofnetwork administrator and not as your claims administrator.ComplaintsIf you are unhappy with ZHCN, you may file acomplaint. You may complain about any part4Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 130417305Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730The Network’s service area consists of 231 counties. The counties in bold and with the * below wereoriginally effective February 16, 2010. Please also refer to the accompanying Dallas*YoungArmstrongHemphillMartinSan Augustine*Atascosa*San JacintoDawsonHendersonMason*Austin*HidalgoDeaf SmithMatagordaSan PatricioBaileyDeltaHillMcCullochSan thMilam*Hunt*SomervellBlancoEctorMills*El MontagueStephens*Bowie*Montgomery tBriscoeFayetteMotleyBrooksFisherJim HoggNacogdoches Taylor*NavarroBrownFloydJim WellsTerry*Fort om OrangeTyler*Palo ebergParmerVan erty*WhartonHaleReal*ColoradoHallLimestoneRed omancheHansfordLive rts6Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730PRE-DESIGNATED PHYSICIAN FORM FOR ON–THE-JOB INJURIESEMPLOYEE TO COMPLETE THIS SECTION:PHYSICIAN TO COMPLETE THIS SECTION:Employee Name:(please print)You can be treated immediately by yourpersonal medical doctor if: You are part of an HMO health plan The doctor treated you in the past and hasyour medical records You give your employer the doctor’s nameand address in writing on this form.Employee Signature:Company Name:Company Address:I agree to treat the above named individual fortheir work injury or illness. I understand thatmedical services in the Texas zation of non-emergency services,utilization review, reporting requirements, andfees governed by the Division of WorkersCompensation. I also agree that, upon treatingthe above individual, I will abide by the terms ofthe Zenith Health Care Network MedicalProvider Manual (available for download atwww.coventryprovider.com) and I will complywith Texas Insurance Code chapter 1305,subchapter D-I and commensurate rulesadopted under these subchapters.Physician Name (please print):Physician Signature:Date:If I get hurt on the job, I want to receivetreatment from:Name of HMO Plan:Office Manager/Billing Contact:Name of Doctor:Street Address:Mailing Address:Address:Phone Number:Email:Telephone number:7Physician Tax ID:Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730[PAGE LEFT BLANK INTENTIONALLY]8Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730ZENITH HEALTH CARE NETWORK WORKERS’ COMPENSATION NETWORKACKNOWLEDGEMENTI have received the “Employee Notice of Network Requirements” that explains how to get healthcare under workers’ compensation insurance.If I am hurt on the job and live in the Service Area, I understand that:1. I must choose a treating doctor from the Zenith Health Care Network.2. I may select as my treating doctor a doctor, whom I selected as my primary care physician orprovider through my HMO Plan.3. I must go to my treating doctor for all treatment for my work injury. If I need a specialist, mytreating doctor will refer me.4. If I need emergency care, I may go anywhere.5. The insurance carrier will pay the network providers all mandated amounts if my injury iscaused by my job.6. I may have to pay for my medical treatment if I get health care from someone not in the ZenithHealth Care Network.The “Employee Notice of Network Requirements” explains all of the above issues in detail. A mapof the Service Area is attached to the “Employee Notice of Network Requirements”.Signature:Date:Printed Name:The address where I live:Name of Employer:9Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730[PAGE LEFT BLANK INTENTIONALLY]10Zenith Health Care Network (ZHCN)NONR (rev 07/01/21)
ZENITH HEALTH CARE NETWORK AND NON-NETWORKServices Requiring sPsychDiagnosticsPT/ OT/ Chiro/home health /gymWork Hardening/ConditioningPainManagement/Other ProgramsDMERxNon-Network – 134.600(p)Non-emergency inpatient admissions(including principal scheduled procedure andlength of stay.)Outpatient surgical or ambulatory surgicalservices. Spinal surgery. Bone growthstimulators would be covered as part of thesurgery so no discrepancy.May require pre-auth as outpatient surgicalservices, depending on billing and whereinjection is performed.Psych testing, psych therapy, repeat psychinterviews, and biofeedback (unless part of apreauthorized or DWC exempted RTWprogram.)Repeat diagnostic study 350 per feeschedule, or without fee schedule value.PT/ OT/ Chiropractic PT/ Orthotics/Prosthetics Management, except for the first6 visits of PT/ OT within 2 weeksimmediately following the DOI or date anapproved surgery was performed.All work hardening or work conditioningservices.All Chronic Pain Management/Interdisciplinary Pain Rehab programs.DME 500 billed charges per item(purchase or expected cumulative rental.)Bone Growth Stimulators would be coveredas part of DME because they exceed 500.00Drugs not included in the Division’sFormulary (aka N-Drugs).Network – 413.014; TIC 1305; 28 TAC 10( Subchapter F)Same all nursing home/ convalescent/ services.Same, and specifies that radiological cryotherapy,manipulation under anesthesia, and certain injections (seebelow) are classified as surgery. All implantable Bone GrowthStimulators. All vertebral axial decompressions (Vax-D), radiofrequency thermocoagulation of facet joints (RFTC), and IDETprocedures;All ESI’s, facet injections, trigger point injections, SI jointinjections, prolotherapy injections, chemonucleolysis, anddiscograms.Same (excluding an initial psych eval.)Same All myelograms, discograms, venograms, surfaceelectromyograms, EMGs, and nerve conduction studies.Same all home health/ residential treatment, and all gymmemberships.Just requires for PT OT no specificsSameSame All chemical dependence and weight loss programsSame All Bone Growth Stimulators, and All TENS units/neuromuscular stimulators/ interferential unitsSameAll drugs created by compounding.(prescribed and dispensed on or after 7/1/2018)Intrathecal drug delivery systems (includingrefills for drugs excluded from the closed formularyor for changes in dosing or changes in doctors)OtherTreatmentOutside of ODGInvestigationalTreatmentTreatment forDisputed BodyParts/ ConditionsRequiredTreatment PlansAll treatment that exceeds or is notaddressed by ODG and which are notcontained in a treatment plan that has beenpreviously approved. All investigational/experimental services not yet broadlyaccepted as the prevailing standard of care.Any investigational or experimental serviceor device for which there is early, developingscientific or clinical evidence demonstratingthe potential efficacy of the treatment,service, or device that is not yet broadlyaccepted as the prevailing standard of care.Any treatment for an injury or diagnosis thatis not accepted by the carrier per §408.0042and §126.14.Mandated URAll chemonucleolysis, vertebral axial decompressions (Vax-D),radio frequency thermocoagulation of facet joints (RFTC), andIDET procedures.SameSameNote: Emergency treatment does not require preauthorizationZHCN-PreauthList-2018-11-07ZIMS 13041730
ZENITH HEALTH CARE NETWORK AND NON-NETWORKServices Requiring PreauthorizationA to Z:Non-NetworkNetworkAmbulatory SurgeryBiofeedbackBone Growth StimulatorsChemonucleolysisChiropractic Therapy*Chronic Pain Management ProgramsCompounded drug (prescribed and dispensed on or after 7/1/2018)Diagnostics- repeat studies 350DiscogramsDME 500Experimental TreatmentHospital AdmissionsIDET ProceduresInjections done in Outpatient Surgical SettingInpatient Hospital Length of StayInterdisciplinary Pain Rehab ProgramsInterferential Units 500Intrathecal drug delivery systems, including refillsInvestigational TreatmentManipulation Under AnesthesiaN-DrugsNeuromuscular Stimulators 500Occupational Therapy*Orthotics Management*Outpatient SurgeryPhysical Therapy*Prosthetics Management*Psych Interviews- RepeatPsych TestingPsych Therapy, Chemical Dependency Programs,Radiofrequency Thermocoagulation (RFTC)Radiological CryotherapyRepeat Psych InterviewsRx outside of ODG (N-Drugs)Spinal SurgerySurface EMGSurgeryTreatment for disputed conditionsTreatment Outside of ODGVertebral Axis Decompression (Vax-D)Work ConditioningWork HardeningAmbulatory SurgeryBiofeedbackBone Growth StimulatorsChemical Dependence ProgramsChemonucleolysisChiropractic Therapy*Chronic Pain Management ProgramsCompounded drug (prescribed and dispensed on or after 7/1/2018)Convalescent ServicesCT MyelogramsDiagnostics- repeat studies 350DiscogramsDME 500 billed chargesEMGs (Electromyograms)ESI’s (Epidural Steroid Injections)Experimental TreatmentFacet InjectionsGym MembershipsHome Health ServicesHospital AdmissionsIDET ProceduresInterferential UnitsInjections done in Outpatient Surgical SettingInpatient Hospital Length of StayInterdisciplinary Pain Rehab ProgramsIntrathecal drug delivery systems, including refillsInvestigational TreatmentManipulation Under AnesthesiaMyelogramsN-DrugsNerve Conduction Studies (NCS, NCV)Neuromuscular StimulatorsNursing Home StaysOccupational Therapy*Orthotics Management*Outpatient SurgeryPhysical Therapy*Prolotherapy InjectionsProsthetics Management*Psych Interviews- RepeatPsych TestingPsych TherapyRadio Frequency Thermocoagulation (RFTC)Radiological CryotherapyRepeat Psych InterviewsResidential Treatment/ ServicesRx outside of ODG (N-Drugs)Sacroiliac (SI) Joint InjectionsSpinal SurgerySurface EMGsSurgeryTENS UnitsTreatment for disputed conditionsTreatment Outside of ODGTrigger Point InjectionsVertebral Axial Decompressions (Vax-D)Weight Loss ProgramsWork ConditioningWork Hardening* Beyond up to 6 sessions performed within 2 weeks of DOI/ Date of approved surgeryZHCN-PreauthList-2018-11-07ZIMS 13041730
Zenith Health Care NetworkHCN License Number: 13041730Red de Servicios Médicos de ZenithAviso para empleados de requisitos de la redSu empleador provee prestaciones de saludpara lesiones relacionadas con el trabajo pormedio de la Red certificada de ServiciosMédicos de Zenith (ZHCN, por su sigla eninglés). La ZHCN incluye médicos, hospitalesy otros proveedores médicos en 231condados que comprenden el área deservicio de la ZHCN.Si usted se lesiona en el trabajo debecomprobar que vive en el área de servicio dela ZHCN. Si vive en el área de servicio de laZHCN, debe recibir toda la atención médicade su lesión a través de la ZHCN.La información en este aviso le explicará elárea de servicio de la ZHCN y le ayudará aobtener atención de salud a través de laZHCN. Si tiene alguna pregunta, puedeconsultar a su empleador o llamar al 1-800841-3987.Administrador de reclamacionesSu administrador de reclamos es:Zenith Insurance CompanyContacto para quejas:Zenith Insurance CompanyATTN: Provider RelationsÁrea de servicio de la ZHCNSe adjunta un mapa del área de servicio dela ZHCN.Si usted vive en el área de servicio de laZHCN, debe escoger al médico de cabeceradel Directorio de Proveedores de la ZHCN.Su médico de cabecera podrá enviarlo a otroprofesional de la salud.Si piensa que no vive en el área de serviciode la ZHCN, puede comunicarse suexaminador/ra de reclamos. Usted tiene quesolicitar una revisión por escrito. Si solicitauna revisión, tiene que presentar pruebaspara demostrar que no vive en el área deservicio de la ZHCN.Su solicitud de revisión debe ser enviada aSu administrador/ra de reclamos.Dirección de envio:21255 Califa StreetWoodland Hills, CA 91367Correo electrónico para quejas:txnetwork@thezenith.com1Acceso a atención de saludCuando así lo solicite, la ZHCN debeconcertar los servicios médicos de maneraoportuna,teniendoencuentasuscircunstancias y su estado de salud. Estoincluye recomendaciones a especialistas. Encualquier caso, los servicios debenconcertarse a más tardar 21 días después dela fecha de la solicitud.Zenith Health Care Network (ZHCN)Su administrador/ra de reclamos revisará susolicitud y dentro de los siete (7) díassiguientes a la recepción de esta, tomará unadecisión y se la enviará por escrito. Si noestá de acuerdo con la decisión de Zenith,puede presentar una queja. Las quejasdeben ser presentadas ante el DepartamentoNONR (rev 07/01/21)
Zenith Health Care NetworkHCN License Number: 13041730de Seguros (vea la sección de Quejas paramás información).Mientras su solicitud se encuentra enproceso de revisión, puede acudir a recibirtodo su tratamiento médico dentro de la red.Para ello, debe seleccionar un médico decabecera de la ZHCN. Todo el tratamientomédico para su lesión de trabajo seráplanificado con su médico de cabecera.Si es determinado que usted vive en el áreade servicio de la ZHCN, es posible que tengaque pagar por el tratamiento médico si fue aun proveedor que no está en la ZHCN.Cómo obtener atención de salud a travésde ZHCNInforme a su supervisor o gerente deinmediato si usted se lesiona en el trabajo.Usted debe escoger su médico de cabeceradel Directorio de Proveedores de la ZHCN.Es posible que necesite que lo envíen a unmédico especialista o a otro profesional de lasalud. Su médico de cabecera de la ZHCNdebe hacer todas las recomendaciones. Sinecesita atención de urgencia, no tiene quepasar por su médico de cabecera de laZHCN.Los proveedores de la ZHCN solo tratarán yfacturaránalaaseguradoradecompensación para trabajadores de suempleador o al administrador de reclamospor los servicios relacionados con unaccidente de trabajo indemnizable. Losproveedores de ZHCN no le facturarán.Puede que desee obtener atención de saludde proveedores que no están en la ZHCN.Para ello, primero debe obtener laaprobación de su administrador/ra dereclamos. Si no recibe la aprobación parautilizar proveedores que no están en laZHCN
Zenith Health Care Network HCN License Number: 13041730 2 Zenith Health Care Network (ZHCN) NONR (rev 07/01/21) While your request is under review, you may seek all medical care within the network. To
