Provider FAQs for NPN Members
What to do if your provider is not currently in the MCA-Sedgwick network.
The following frequently asked questions (FAQs) provide information on what to do if the Nationwide Provider Network (NPN) provider you have been seeing for your WTC-related care is not currently in the Managed Care Advisors (MCA)-Sedgwick network. You should always have access to your WTC-related health care.
Why is my provider not in network?
Unfortunately, not all providers that were available under the previous Nationwide Provider Network (NPN) administrator are currently available through the Managed Care Advisors (MCA)-Sedgwick network. This can be for a variety of reasons, from not being in the various networks that make up our NPN network to no longer wanting to be part of the Program.
While we are constantly enrolling providers into our network, this can take some time (often several months) and is not guaranteed.
What do I do if the NPN provider I am seeing is not in network?
First, do not worry – you should not and will not go without care! Call the MCA-Sedgwick member services team as soon as possible. We will discuss with you whether it is safe for you to change providers at this time. The outcome of that conversation will determine next steps.
What if I am in the middle of critical care and cannot change providers right now?
We understand that certain types of care can make it problematic to change providers, such as active mental health treatment, active cancer care, care for interstitial lung disease, or hospice care. If we determine that it is not safe for you to change providers, we will work with your existing provider immediately to enroll them in our network. If they do not wish to enroll at this time, we will see if they will agree to continue to provide WTC-related care just for you until it is safe for you to transfer to an in-network provider. If they do, we will send you a letter approving you to continue to see that provider temporarily. Again, do not worry. You should not and will not go without care!
What if I am not in the middle of critical care and my provider is out of network?
If your care needs are not critical, we will reach out to your existing provider to enroll them in our network. This can take some time and is not guaranteed. The provider enrollment process can take several months to complete. Because of this, you may need to see an in-network provider while we try to enroll your existing provider. If this is necessary, we will work with you to select an in-network provider and will schedule the appointment for you.
If an in-network provider is not available near you, you may be allowed to continue to see your existing provider temporarily while we work to enroll a new provider near you to see moving forward. This is done on a case-by-case basis. If you are allowed to continue seeing a provider like this, you will receive a letter documenting the approval.
If your existing provider decides to enroll in our network, you may resume seeing your original provider once that process is complete. Again, it is not guaranteed that your provider will enroll. Sometimes providers decide not to participate in various public or private health programs for a variety of reasons.
Can I change providers even if my existing provider is already in network?
Yes! You are always welcome to change providers, as long as the new provider is also in-network. Please reach out to MCA-Sedgwick for assistance in changing providers. Our team will help find a provider in our network and will help schedule your first appointment.
Will I ever have to go without WTC-related care?
No! MCA-Sedgwick and the WTC Health Program have worked hard to ensure that your care will continue even if your existing provider is not in network. We know this can be a stressful situation and we are here to help.
Please call us (MCA-Sedgwick) at 1-800-416-2898 if you have any questions or concerns. You can also reach out to us via the NPN Member Portal chat feature.
If you are having trouble accessing your WTC-related care, reach out to us (MCA-Sedgwick) immediately so we can make it right. If you have a Program-level issue or complaint, you can email wtc@cdc.gov to reach the WTC Health Program directly.