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Member
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Join Date: Jan 2009
Location: Paradise
Posts: 855
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Member
Join Date: Jan 2009
Location: Paradise
Posts: 855
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Quote:
Originally Posted by Jo*mar
This wasn't meant to be a political or health care thread.
{limited political discussion as stated in NT guidelines}
Mainly was posted asking for info if others are getting these Utilization Reviews.
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There are a couple level of appeals with UR that are possible for the patient and treating doc as first requests for authorization are frequently denied or are cut by UR to where the proposed treatment is meaningless. One can go outside of the system at some point for unauthorized and eventual litigated treatment, but options are even more slim there for quality care. There are few happy WC patients in CA! If you are in CA, your doc must be experienced in dealing with the ACOEM Guidelines and the appeals process.
But getting back to your original question, UR is mandated before treatment is authorized. Every darn case goes thru UR whether it is with a private insurer, self-insured or thru the state compensation insurance fund (state run insurance for those who cannot find a private WC insurer, but they are not cheap!)
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