I am being blanketed with those "Utilization Reviews." Is anyone else???

If so, will you PM me?

I am contacting news media about the misuse of the URs, but for instance, the Northern CA papers want a No Cal patient to include.

I am desperate to find others being abused.

I remember a few had various problems with getting meds & treatments - they wrote their congressman /representative and explained the issues and I think most got positive action from it.

wc or pvt ins - shouldn't matter really - the politicians need to know what is happening & how the "system" is not working for so many in it.

You can surely use me! My insurance has been denying everything after approving everything for years. Bring in physicians to refute the procedure who has no expereince nor education in the field. Case workers who have not earned a shield making decisions.

Just the beginning of our new health care woes. Can you imagine government employees in Washington making decisions on our health care? 18 million dollars to lobby one special interest? These monies can be put towards social security and health care.

Tam, I think this and similar is not limited to CA, not limited to TOS, and not limited to WC. I remember when it all started going downhill, long before Hillary was on the scene. Copays went up every year. The only good docs on PPOs were not taking new patients. Many specialties were not represented on PPO and POS lists in many insurance companies. If you found a doc that took WC it was almost a given he was incompetent.

One wakeup call was when I had a very painful ear infection, but when I tried to pick up my prescription for antibiotics, the insurance would not cover it. The doctors office was closed on a Friday so they expected me to cough up money I honestly did not have or to wait till Monday for a cheat antibiotic to be prescribed.

Another wakeup call was when my right hand was injured, and strength testing showed it was all better, because it was as strong as an average woman. In actuality it was almost as strong as my very weak left hand. To this day this attitude still horrifies me.

Utilization Reviews are specific processes by which the work comp ins. co. gets your doctor's report, and in it, your doctor wants to give you medication and/or do some things to help you. The adjuster then objects to that report, sends out for a UR decision, and she can delay it, and she can use doctors who have never seen you or aren't even in the specialty, and then deny your treatment in full or in part. Then your doctor must write why he/she thinks it's necessary. All the time you are going without.

Your attorney (or you) only has one option and that is to file for an expedited hearing, which the attorneys do not yet know how to get attorneys fees for. (I would attach a motion for fees based upon frivolousness, etc.) Almost all attorneys will either NOT do an expedited, and leave you hanging, or only do one. I've been sick 8 years, so my atty has done 3. But this year I got about 6 URs and no one would do anything they were supposed to.

This process is NEW and a result of NEW laws that came in by Schwarzeneggar. And I voted for him! (Idiot me.)

In general, I do not like ins. co.s in the healthcare field as their involvement does not create income, their involvement and goal is to siphon off funds for their own profits. It is inherent in their involvement that someone somewhere who is a patient will not get what they need becase they have to pay the ins. co. bills and make a profit. So I am NOT opposed to government involvement in health care as my Medicare is quite reliable and workable. Their decisions are appealable and I've never lost. My experience with work comp is different.

I have a strong feeling that the "word" is out to blanket us with URs, as a new tactic. I want my judge to hear what is going on.

But, I ask, besides Olecyn, and I thank you for offering to join in if I get a reporter or someone to listen to me, is anyone else getting these URs as a way to deny help?

And you do know that for them to use your Medicare for even one penney of care of your work comp injury is illegal, right? I think my ins. co. got mad because I called them on their practice of using Medicare to pay for meds (and acting like they didn't know...)

If you are over 70% disabled by work comp then you get lifetime medical but what is that worth if they constantly UR your doctor? And in my case, it should happen only every 60 days but they are doing it as much as 25 days, and I went without any treatment or meds for 75 days straight when they delayed another. This is not medical care, this is harassment and bad faith.

Im new to this forum and I havent read many posts on this forum yet. However, I do know something about WC and was wondering if you went to the CA state department of insurance about the problems you are having??? They may be able to help????? Good luck and all the best to you!

O yeah, been there done that but the more who do write the more attention it will get. Unfortunatley, Ins Commissioner cannot override the workerscomp rules and laws however they do keep the information sent. Write your congressmen and the governor. A case has been opened in my behalf. However, my attorney to stop with the letters as it fuels the insurance company. I laughed saying and thats exactly what needs to be done instead of waiting till the end of time when and if this case ever gets resolved. Its all about the principal of insurance company's not providing medical care, delays and denials for patients who could get better not allowing them to. They would rather be fined 10-15years down the road for the delays and denials than pay out for what is needed.