To become a certified PPO in the State of New York, please contact the WC Program Director in the NYS Dept. of Health at (518) 474-5515.

View list of Active PPOs

The PPO (Preferred Provider Organization) program establishes procedures and protections governing the ability of an insurance carrier/TPA/Self-Insured employer to direct claimants to seek all medical services from a network of providers. This is in with accordance with Article 10A of the Workers Compensation Law, NYCRR Subpart 325-8 and NYCRR Title 10 Part 732 - these became effective on January 1st, 1997. The claimant is required to utilize the PPO network provider for the first initial visit. A claimant can wait 30 days after the initial visit to the PPO provider in order to opt‐out (written notification to employer/insurer). An employer/insurer can seek a second opinion from another PPO provider.

Yes, if you have received written notification (an email, notice on employer website, letter or poster in your employer's break room or common room), you are required to seek treatment with any provider in the PPO network. If you do not use the PPO provider, the insurer could deny payment of your medical bill.

You can choose to opt‐out of your employer's PPO provider network by notifying your employer in writing (simple letter specifying your intent to opt‐out of the PPO program). You will need to wait 30 days after the initial visit to the PPO provider to seek treatment from your preferred provider. The employer/insurer has the right to require that you seek a second opinion from another PPO provider.

This consent form is only used in conjunction with a Recommendation of Care (ROC) program. A consent form should only be signed at the time of injury. It should not be signed prior to an injury. The form is an acknowledgment that the claimant can receive medical services from an employer/insurer recommended provider network. By signing this consent form, the claimant is still able to utilize this recommended network or any other WC Board authorized provider.

View list of Active PPOs and contact the identified PPO Administrators directly.

An insurance carrier or self-insured employer can discount your bill if you have signed a business contract to accept a discounted fee schedule. This contract does not have to be with a certified PPO network entity. If you do not believe that you signed a contract, ask the employer/insurer or their bill review company to send you a copy of the contract.

If the insurer/TPA or employer has not responded to your request for your provider contract, please file a Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0) with the Board. You should also contact the claimant to file a Request for Assistance by Injured Worker (Form RFA-1W) on your behalf to schedule a Workers' Compensation Law Judge hearing.

If a contract exists whether old or not and you have not terminated your business arrangement to receive discounted fees for services related to NYS WC claims, you must accept the discounted fees for services previously rendered. To terminate this contract you must send a termination letter to the PPO.

Insurers/TPA can restrict patients from receiving treatment from out-of-network providers. If a claimant would like to continue treatment from out-of-network providers, the claimant can opt‐out from the PPO network by notifying their employer/insurer/TPA in writing of this intent. The insurer/TPA can also seek a second opinion from another PPO network provider.

Insurers/TPA can restrict patients from receiving treatment from out-of-network providers. If a claimant would like to continue treatment from out-of-network providers, the claimant can opt‐out from the PPO network by notifying their employer/insurer/TPA in writing of this intent. The insurer/TPA can also seek a second opinion from another PPO network provider.

Yes, if the patient's employer/insurer has a PPO contract, the patient is required to use the PPO provider network. This is in accordance with the PPO rules and regulations effective from January 1st, 1997.

The claimant has a right to opt-out of the PPO program. The claimant must notify their employer/insurer/TPA in writing of this intent. The insurer/TPA can also seek a second opinion from another PPO network provider.

All insurance carriers and self-insured employees who have contracted with a PPO for medical services shall report to the Chair the names and addresses of the insured employers who have elected to utilize the PPO. Insurance carrier and self-insured shall also report to the Chair, in a prescribed format specified data relating to utilization, quality of care, costs and outcomes. Please email MCNetworks@wcb.ny.gov for questions.

Insurance carriers shall submit to the Board a copy of the New York Compensation Insurance Rating Board's PPO Endorsement (WC 31 06 16) or the New York PPO Premium Endorsement (WC 31 04 03) for each employer electing to utilize a New York certified PPO (see PPO Arrangements for Insurance Carriers link). This notice should filed within 10 days of the effective date of PPO participation or whenever there is premium renewal. The endorsement copies can be emailed to MCNetworks@wcb.ny.gov.

Subpart 325-8 of Title 12 NYCRR requires that an employer should submit a notarized affirmation signed by any collective bargaining agent(s) confirming PPO participation. This notice should filed within 10 days of the effective date of PPO participation or whenever the collective bargaining contract is renewed. The affirmation copies can be emailed to MCNetworks@wcb.ny.gov.

Self-insured employers do not need to file the endorsement notices. However, a self-insured employer will need to file the registration form found on the Board website - follow the Preferred Provider Organization Arrangements for Self-Insurers link. Subpart 325-8 of Title 12 NYCRR requires that a self-insured employer should submit a notarized affirmation signed by any collective bargaining agent(s) confirming PPO participation. This notice should filed within 10 days of the effective date of PPO participation or whenever the collective bargaining contract is renewed. The affirmation copies can be emailed to MCNetworks@wcb.ny.gov.