Medical Cost Containment

Management of the medical expense portion of a claim is critical. Medical claim costs can escalate quickly, so OneBeacon works with key partners to deploy a full array of cost containment programs. These programs begin immediately after an injury occurs and will continue as long as treatment is medically necessary. Our cost containment programs include:

  • Preferred provider organizations:
    We utilize the Coventry PPO in all states except, NJ and NY.
    • To look up providers, please visit: www.coventrywcs.com.
    • Select “Client Login & Tools” in the top right center of the homepage. Type the Client ID of ONEBEA and select the arrow to the right of the field.
    • Select “Channeling Tools” which will display The First Health Network. The channeling tool allows you to search for a Network Provider by address, name, region, as well as allowing you to create a Work Site Poster.
  • For NJ and NY, we utilize the Procura Network.
    • To look up providers, please visit www.procura-inc.com
    • Select “Find a Doctor, Hospital or Facility” from the Quick Links on the right-hand side of the homepage.
  • California MPN
    • To look up providers, please visit: www.coventrywcs.com.
    • Select “Client Login & Tools” in the top right center of the homepage. Type the Client ID of BEA and select the arrow to the right of the field.
    • Select channeling tools which will display The First Health Network. The channeling tool allows you to search for a Network Provider by address, name, region, as well as allowing you to create a Work Site Poster.
    • The requirements for CA employers can be found in the publication: Atlantic Specialty Insurance Company-Select MPN or Rhode Island Employers with California locations.
    • The MPN provides MPN Medical Access Assistants within the United States who are available Monday – Saturday, 7:00 a.m. to 8:00 p.m. Pacific Time to provide employee assistance with access to medical care under the MPN.
California MAA ContactCalifornia MPN Contact
Phone: 888.937.1663
Fax: 866.819.8201
Email: CAMPNMAA@onebeacon.com
Graham Cadwallader
Workers Compensation Claim Supervisor
188 Inverness Drive West
Suite 600
Englewood, CO 80112
Phone: 877.440.6274
Fax: 866.984.5094
GCadwallader@onebeacon.com
  • Regulatory restrictions prevent us from broad PPO utilization in KY, LA, and TX.

Pharmacy First Fill Program 

  • First Fill Program – A prescription drug card program designed to ensure that the injured worker receives their initial medication as soon as possible after sustaining an injury, even before the claim is accepted as compensable.  This program provides access to our national network of over 60,000 pharmacies with NO out-of-pocket costs for the injured worker.  There is an $85 cost limit and a 10 day supply limit and the temporary card expires 30 days after the injury.
  • Once a claim is accepted as compensable, generally within 7-14 days, a personalized prescription card will be mailed directly to eligible claimants allowing full refills of covered prescriptions. 
  • Our PBM’s will absorb the cost of the first fill prescription if the claim is later denied or the medications are unrelated to the injury.  OneBeacon covers the costs of the first fill prescriptions for injury related medications that are medically necessary on claims that are ultimately accepted as compensable.
    • For CA, CO, CT, GA, MA, MN, NJ, NY, PA & VA, our Pharmacy Benefit Manager is TMESYS.  To locate participating pharmacies, please visit www.tmesys.com
    • For all other States, the Pharmacy Benefit Manager is FirstScript.  To locate participating pharmacies, please visit www.firstscript.com/pharmacy