The World Trade Center Health Program (WTCHP) uses a network of medical providers to ensure 9/11 first responders and survivors who live outside of the New York City metropolitan area can receive the care they need to treat their 9/11-related conditions. Over the past decade, the WTCHP has enlisted the services of Logistics Health Incorporated (LHI) to manage claims and find appropriate doctors and medical providers for 9/11 claimants.
While LHI has assisted 9/11 claimants with receiving access to healthcare, numerous complaints over the past few years have shed light on a deteriorating program that leaves far too many 9/11 first responders and survivors helpless when it comes to receiving necessary medical treatment. An investigation by NBC News found that “the program was failing to pay medical bills, providing inadequate treatment options and neglecting to address the needs of a population with significant rates of post-traumatic stress disorder.”
As such, the WTCHP has contracted with a new third-party vendor, Managed Care Advisors (MCA)-Sedgwick. The vendor’s job is to manage WTCHP claims for individuals who live outside of the New York City metropolitan area.
MCA-Sedgwick to Take Over in Late Spring 2022
In early February 2022, the WTCHP notified all National Provider Network (NPN) members of the change in vendor from LHI to MCA-Sedgwick. The change is to take place in late spring 2022, however, there will be a transition period to ensure WTCHP claimants have continued access to WTCHP benefits. As such, WTCHP NPN members should continue accessing their LHI accounts until further notice from the WTCHP.
What Changes Can You Expect as a WTCHP NPN Member?
As an NPN member who has received WTCHP-mandated benefits through LHI’s management, you should expect to experience the following changes once MCA-Sedgwick fully takes over LHI’s duties in late spring 2022:
- Provider Changes – The majority of NPN members should be able to continue seeing the same healthcare providers they have previously seen through LHI’s management. If for some reason the same healthcare provider is not available, MCA-Sedgwick will contact affected NPN members to help them find a new, qualified provider to carry on care and treatment, including mental health treatment.
- Case Manager and Care Coordinator Changes – Once the transition has been made from LHI to MCA-Sedgwick, a new care coordinator and/or case manager will be assigned to each NPN member who previously had a case manager or care coordinator with LHI.
The overall goal in switching vendors for NPN members is to ensure easy access to mandated benefits and medical treatment for 9/11-related conditions. Limiting confusion, stress, and uncertainty are critical to all 9/11 survivors and first responders who require care, especially those who are receiving mental health treatment. It is too early to tell, but we are hopeful that this vendor change will provide superior service and compassionate care to all members.
Our Experience with LHI as 9/11 Lawyers
If you are an NPN member who has dealt with LHI over the past decade, you may have had a good experience or you may have had a terrible experience. Many WTCHP claimants who are NPN members did not have a good experience with LHI, finding it difficult to speak with a care coordinator and obtain approval of benefits. In some cases, care coordinators were frequently changed or were absent. Such dissatisfaction may have contributed to LHI losing its contract with the WTCHP in late 2021.
By working with a 9/11 lawyer, NPN members have an advocate who can help to streamline the transition from LHI to MCA-Sedgwick. Such a process can be difficult for 9/11 claimants who require assistance to communicate with providers and ensure all benefits are covered by the WTCHP.
At Pitta & Baione, we represent numerous 9/11 clients who have experienced the pitfalls stemming from LHI’s failures to meet the needs of survivors and first responders. While we are hopeful that MCA-Sedgwick will do better than LHI, we strongly believe our clients deserve a strong support system to hold vendors accountable when they fail to administer and approve benefits in accordance with the WTCHP.
Contact the 9/11 Lawyers of Pitta & Baione Today For a Free Consultation
If you are a 9/11 survivor or first responder and believe you are eligible to receive medical benefits through the WTCHP, it is important to speak with a 9/11 lawyer who can provide you with the guidance you need. At Pitta & Baione, we assist 9/11 claimants who live both within and outside the New York City metropolitan area. To schedule your free consultation to speak with one of our 9/11 lawyers, contact Pitta & Baione today by calling (212) 210-1775.
