Unfortunatley, being a w/c patient the insurer can rightly deny any and all ER claims. You need to be followed up by your w/c physician. Go often, go as much as you need to go relating to your injury. I found out the ER issue the hard way. So, its true. The rules state you must get permission to go to the ER from the insurer. LOL...so when do we know when the ER is needed? O yeah, I plan on having SOB, my extremities will be turning blue and pain so high it cannot breathe on Saturday 1:56am. Its called dictated medical care. However, the insurer will pay for true life threatening conditions which they put conditions on.

1 instance I had a severe reaction to a medication...I went to the ER from work and was reprimanded by the insurance company that i should have gone to the clinic. They couldnt have helped me, I needed ER attention and meds the clinic didnt offer. Another time I couldnt breathe not knowing I developed pleurisy from a w/c procedure needle poke. Well, I had to have a PET, MRI's & CAT with contrast, then drain my lungs as in a thoracentesis. 2 weeks worth of testing and hospitalizations. They refuse to pay for it to this day since it was not approved before going to the ER. It was a weekend. What is a person supposed to do?

My former PMD told me i should immediately go to the ER so my husband took me, now what do we do? Thanks so much again!

My former wc claim was denied but I got treatment using my pvt medical ins as the secondary insurer.
I can't recall if my atty suggested that or how it came about. Maybe the billing dept of the PT place.. came up with it.
this was in Oregon, not CA.

But treatment was for the wc injury so it was listed as Ins #1 and my pvt medical was as secondary payer.

and also since my claim denial was being appealed all bills could be placed on hold. {atty wrote a letter to billers}.

So nearing the end {hearing/settlement} all bills on hold had to be gathered up and listed - some were paid directly by the insurer and some were left for me to pay out of the settlement.

If you have an approved and accepted claim this may not help much..

Unfortunately wc does not really seem to care if you get proper care or not...

You have to do what is needed for your best care, if you can figure out a way to get treatment without messing up your claim..

I did go out on my own and pay a bit of cash to a chiro & PT person for some specific help - and they were the best help I got...!

But I had/have an RSI/TOS injury and not RSD.

This might make you laugh......

I've had 1 ER visit for my neck pain/RSD basically for meds. I had Vicodin 7.5/750 mg q 4 hours prn. I had a flare that required I use it q 4 hours when I normally only took 1 or 2 a day. Every 4 hours was too much Tylenol, primary was supposed to call in a script without Tylenol, but didn't and covering MD told me to go to the ER. I told ER doc the issue and he wrote a script. No exam, no tests, just gave me what I needed

WC denied the visit.

Prior to my injury, I worked for the hospital. That hospital's WC denied my visit to their own ER. Doh !

Because they have my regular insurance info on file, the hospital just billed my normal health insurance, who paid it, BUT......I got sent the bill for the deductible. I refused to pay it. I actually surprised my insurance covered it.....no exam, no treatment, just the script.

And now my credit rating has one big glaring negative........that stinking $25 co-pay

Azaila - Here is a creative thought. Even if compensation were not an issue, an ER is not a dependable source of care for RSD.

I am not an expert in workers comp., other than to know that in CA the docs do not get paid until your case is settled, making a financial disincentive for them to take WC cases. I noticed that you live in L.A. Among the best treatment in CA for RSD is at the UCSF Pain Management Center. Because they are a government-funded center, they must accept all patients. The catch is that they require a referral from another physician (this could even be your internist) and act on a consultant basis (they see you on a regular basis, treat you (i.e. stellate blocks), and determine your prescriptions. But your on-going management for your medications between your appointments @ UCSF is taken over by your referring physician (i.e. your internist).

UCSF has physicians who do research into RSD, and patients with RSD are treated with respect and credibility. You would not need to produce your MRI, CT Scans, or X-Rays, because they know that none of these are tools used to diagnose RSD. UCSF is only a one-hour plane flight away on inexpensive Southwest. Your travel expenses tax deductible.

Do you have any doctor who can write you a simple letter of referral? You can get the simple procedure from their website or by calling them and your internist can be used as the referring physician. You would have the some of best medical care in the state and I think they have to accept your WC.

WC makes it difficult to get good care. This might be a way to get the best.

Skooz: Primary Treating Physicians do not have to wait for your case to be wrapped up before being paid for WC. There are many reasons why docs dislike the WC system in CA, but that isn't one of them.

Also, WC would not allow her to travel to SF for care. They would be responsible for her travel and accomodations.

OP: Your PMD told you to go to the ER, because they get sick of urgent/emergency calls from pain patients. It won't make it covered by the insurance.

A PMD often won't be able to accomodate getting you in early because their patients are so much needier than a normal doc's. So that their lives don't become over run by pain patients, they are less accomodating, not more. That is why choosing a Primary Treating Physician you can develop a relationship with is so important. Did the ER visit accomplish anything?

Your initial post made it sound like you were interested in finding the right care, now it seems what this is really about is a billing question. Call your attorney, he/she should deal with it.

If your husband has become well versed on the CA WC system, he should have told you the problem with getting WC to pay for an ER visit. If you have RSD, you'll be dealing with the WC system for a very long time. It would be in your best interest to put your energy into finding a Primary Treating Physician and personally learning about the very complicated WC system here in CA.