WIXLIB

GRAND PRAIRIE INDEPENDENT SCHOOL DISTRICT504 WORKERS’ COMPENSATION MEDICAL CARE PROGRAMChapter 504 of the Texas LaborCode allows political subdivisionsto create their own Workers’Compensation Medical CareProgram to provide care for itsemployees. GPISD has elected tojoin with other governmentalagencies to provide this newprogram to care for employeeswho are eligible for Workers’Compensation.Effective September 1, 2013,employees with on-the-job injuriesor illnesses must use a primarymedical care facility approved toprovide medical care for employeesinjured on the job. The newprogram is designed to provideemployees with quality, efficientand effective medical care for onthe-job injuries or illnesses. Over110 primary care doctors and 70specialists have been approved toprovide medical care.To get their medical carepaid for, employees must use anapproved primary medical carefacility. Employees that fail to doso, aside from an emergencysituation, will be financiallyresponsible for their ownmedical care. It is veryimportant all employeesunderstand the requirements ofthis program so they don’t findthemselves in a situation wheretheir medical bills are notcovered.In this packet you will findadditional information, includinga list of the primary medical careprovider facilities, and programcontact information.The information in this packetwill help you receive the care youneed under the GPISD Workers’Compensation 504 Medical CareProgram.What to do if you are injuredon the jobEmployees have an obligation toimmediately report their on-the-jobinjury or illness to a supervisor.The 504 Medical Care Programdoes not change GPISD’s reportingrequirements. You will be requiredto provide the same informationthat is currently gathered.Each time an injury or illness isreported, you will be provided a listof primary medical care facilities.If medical care is required, you willbe asked to select a facility thatwill provide medical care for yourinjury or illness. Your selection willbecome part of your claim file.Once you’ve provided the lossinformation, and selected theprimary medical care facility whereyou will be receiving your medicalcare, you will receive a programacknowledgement form authorizingyou to seek medical care under the504 Medical Care Program. Thisform will require your signature.How to locate an approvedprimary medical careprovider facility within the504 Medical Care ProgramTo locate an approved primarymedical care provider facility inthe 504 Medical Care Program,refer to the list of PrimaryMedical Care Provider facilities–1–provided in this packet/brochure. Ifyou are injured on the job, yoursupervisor will provide you with acurrent list of approved facilities.You may also access the list ofprimary medical care facilities inthe Risk Management Department.Select a primary medical careprovider facility of your choicefrom the list. All medical care forwork-related injuries and illnesses,other than emergencies, shall beobtained through the 504 MedicalCare Program.What to do if you need emergencycare or after hours careIn case of an emergency, inor out of the program servicearea, call 911 or go to thenearest emergency treatmentfacility.If you need non-emergencycare after hours, consult thelist of approved primarymedical care provider facilitiesfor a location that hasextended hours. A list of thefacilities is included in yourbrochure.How to obtain a referral to amedical specialistAll medical services, other thanemergency care, must be providedby a primary medical care providerfacility that has been approved underthis program. If a specialist’s care isrequired, you will receive notice of aspecialty referral from the primarycare provider overseeing your care.Continued

GPISD Workers’ Compensation 504 Medical Care ProgramWhat to do if you live outsidethe 504 Medical Care Programservice areaThe 504 Medical Care Programprovides access to primary medicalcare providers or hospitals locatedwithin a reasonable distance fromwhere you live or work. If youbelieve you live outside the 504Medical Care Program service area,you may notify the 504 MedicalCare Program Administrator andrequest a review of yourcircumstances. Your requestshould be sent to:504 Medical Care ProgramAdministrator801 South CentralExpressway, Ste. 440Richardson, TX 750801-877-899-2010wcadmin@argusservices.netYou must provide evidenceto show you do not live withinprogram service area. You willreceive a written response fromthe 504 Medical Care ProgramAdministrator.During consideration of yourrequest or appeal, you may stillchoose to receive medical careservices from the 504 Medical CareProgram. If it is determined you dolive within the program servicearea, you may be responsible forpayment of any out-of-service areamedical care you received.How to change your primarymedical care provider facility ifyou are not satisfied with yourinitial choiceIf you are not satisfied with yourinitial choice of provider, you havethe right to select an alternateprimary medical care providerwithin the facility you are currentlyreceiving care, or elect to receiveyour medical care at an alternateapproved primary medical careprovider facility.If you want to change yourprimary care provider, youmust contact the 504 MedicalCare Program Administrator at1-877-899-2010, or 214-4592000. If your alternate choiceis an approved primary careprovider under the 504 MedicalCare Program, your alternatechoice may not be denied. Anemployee must get approvalfrom the 504 Medical CareProgram Administrator tomake a second or additionalchange in medical careprovider.Who to contact if you have acomplaint concerning the504 Medical Care ProgramIf you have a complaint aboutthe 504 Medical Care Program,you must file it with the 504Medical Care ProgramAdministrator. The complaint canbe provided in writing, email ortelephone.To file a complaint, contactthe Program Administrator at:The complaint should includeyour name, address and telephonenumber, name of your employer,and the reason for the complaint.If you are not satisfied with the504 Medical Care ProgramAdministrator’s response, youmay contact Risk Management at972-237-5392. If your complaint isstill not resolved, you may contactthe Texas Department ofInsurance (TDI) to file a complaint.You may obtain a complaint formfrom TDI at:HMO DivisionMail Code 103-6ATexas Departmentof InsuranceP.O. Box 149104Austin, Texas /consumer/complfrm.htmlTo talk to the GrandPrairie Risk ManagementOffice please contactJason Hardy.972-237-5392 office972-237-5589 faxjason.hardy@gpisd.orgGrand Prairie ISDRisk Management2602 S. Beltline RoadGrand Prairie, TX 75052504 Medical Care ProgramAdministrator801 South Central Expressway, Ste. 440Richardson, TX �Continued

GRAND PRAIRIE INDEPENDENT SCHOOL DISTRICT504 WORKERS' COMPENSATION MEDICAL CARE RENOWCARENOWCARENOWCARENOWHOURSADDRESSHours: M-F- 8am-10pm Saturday5301 William D Tate Ave8am-8pm(Glade Rd & Hwy 121)Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday1218 W McDermott8am-8pm(Alma & McDermott)Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday5405 S. Cooper Street8am-8pm(Cooper&Green Oaks)Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pm1501 SW Wilshire Blvd.Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday1017 W. Hebron Parkway8am-8pm(Hebron Pkwy & Old Denton Rd)Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday345 N. Hwy 67 (S. Beltline (1382) &8am-8pmN. Highway 67)Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pm Sunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmHours: M-F- 8am-10pm Saturday8am-8pmSunday- 9am-5pmCITYZIPTELEPHONE #(Bedford-Euless) 5010972-939-9495Cedar Hill75104972-956-5300I-20 & Wheatland,39769 LBJ FrwyDallas75237972-780-080214856 Preston Rd Suite 100(Preston Road & Beltline)Dallas75254972-387-89003751 South I-35E(Mayhill Road & I-35E)Denton76210940-383-27007400 McCart Avenue(McCart & Sycamore School Rd)Fort 661 EastChase Parkway(EastChase Pkwy & I-30)Fort Worth7232 North FreewayFort Worth-Fossil Creek3520 NW Centre Dr(NW Centre Dr-West of 820)Fort Worth-Lake Worth76135817-375-2100Frisco-Preston Road75034972-529-4545301 W. Main Street(Main Street & FM 423)Frisco-West75034972-335-00307145 N George Bush Turnpike(Shiloh & George Bush Tpke)Garland-North75044972-530-1900565 West I-30(I-30 & Beltline/Broadway)Garland-South (Mesquite)75043972-303-30303950 S Carrier Parkway Suite 110(Carrier Pkwy & I-20)Grand Prairie75052972-264-585876051972-539-63305644 Preston Road2355 Grapevine Mills Circle E(Front of Grapevine Mills Mall)Grapevine76137817-439-8100400 Mid Cities Boulevard(Hwy 26 & Mid-Cities Blvd)Hurst76054817-428-7300720 South Main Street(Hwy 377 & Bear Creek Pkwy)Keller76248817-431-2800809 N. Central ExpyMcKinney75070972-529-45003821 W. Spring Creek Pkwy(Coit & Spring Creek)Plano75023972-599-0077CONCENTRAMon.- Fri.- 8:00 am - 8:00pm Sat.8 am -5:00pm15810 Midway RdAddison75001972-458-8111CONCENTRAMon. - Fri.- 8:00am -8:00pmSaturday- 9:00am- 5:00pm Sunday9:00am-5:00pm2160 E. Lamar Ave.Arlington-North76006972-988-0441