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P&S with restrictions but no disability rating. What?
#81
(05-26-2017, 08:23 PM)California_Help Wrote:
(05-24-2017, 01:25 AM)1 Hurt nurse Wrote: Yeah, my doc will send it but utilization review has already denied all recommended treatment.
Uphill battle especially now that they have an attorney. This system is so difficult

Hurt nurse make sure your doctor is sending in his requests on the correct form called an RFA. The link I provided you previously has those forms if you want to print to give to your doctor.

California workers compensation follows MTUS guidelines. ACOEM and ODG. If you want something approved you really need to submit with those guidelines or if your condition or request goes outside of those guidelines, you can submit others by searching internet for example. You as a patient can also submit a UR appeal to the UR company directly addressing the reasons for the denial. There is usually a 5-10 day deadline for this. If you need help with this I can help. The MTUS guidelines are also on the states webpage. What I have done is research guidelines needed and gently hand them to my doctor and say if this can help...and it usually does.

You can shop around for an attorney to take your case. I do not think they would take 15% but that would be up to a judge.

Being out of state it is important to close out your medical if all of your medical treatment is being denied, in my opinion. You should be submitting receipts for reimbursement. There is mileage forms on the states website and I use them and black out the mileage info. I number each receipt and tape them to a piece if typing paper. You should ask your doctors office for a copy of his report for each visit and attach it as well.

Again, if he is not sending in the RFA form they can legally ignore his treatment requests. I can show you how I do internal UR appeals or gather appropriate rational to make a strong request using treatment guidelines. Most (not all) of my appeals go in my favor and some doctors are now using my system. If you need my help let me know.

It's like you read my mind. I so need your help on this.
 
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#82
I tried to edit my last post but was not able to. This is updated with some links.
Let me know when I can help you. I will send you a private message with some additional info on how to make solid requests and/or appeal UR denials. Again if the RFA form is not being used they can legally deny it. It is very easy to fill out.


Hurt nurse make sure your doctor is sending in his requests on the correct form called an RFA. The link I provided you previously has those forms if you want to print to give to your doctor.

California workers compensation follows MTUS guidelines. ACOEM and ODG. If you want something approved you really need to submit with those guidelines or if your condition or request goes outside of those guidelines, you can submit others by searching internet for example. You as a patient can also submit a UR appeal to the UR company directly addressing the reasons for the denial. There is usually a 5-10 day deadline for this. If you need help with this I can help. The MTUS guidelines are also on the states webpage. What I have done is research guidelines needed and gently hand them to my doctor and say if this can help...and it usually does.

Here is link to MTUS guidelines.
https://www.dir.ca.gov/dwc/mtus/mtus_reg...lines.html

Here is link to MTUS chronic pain guidelines.
https://www.dir.ca.gov/dwc/DWCPropRegs/M...icPain.htm

There is a link on the internet to free ODG guidelines (I have to look for it).

You can buy ACOEM 2nd edition guidelines book.

I have used other treatment guidelines if the request or the patients condition fall outside of these guidelines for example Medicare guidelines, Aetna guidelines and peer review studies. This I got from google search. If you want to get fancy you could go to a medical library and I am sure find more. I have gotten so good at it that I have used these to appeal a few private insurance denials.

I also have a system of look up for guidelines and rational to approve requests I do not want to share on public website but will send in a private message if you need it.

You can shop around for an attorney to take your case. I do not think they would take 15% but that would be up to a judge.

Being out of state it is important in my opinion to close out your medical if all of your medical treatment is being denied. You should be submitting receipts for reimbursement. There are mileage forms on the states website and I use them and black out the mileage info and write in reimbursement info. I number each receipt and tape them to a piece if typing paper and attach. You should ask your doctors office for a copy of his report for each visit and attach it as well as your insurance company stated that is needed to request reimbursement. I assume they are not paying your doctor? Have they paid for any treatment, medications etc?

Again, if he is not sending in the RFA form they can legally ignore his treatment requests. I can show you how I do internal UR appeals or gather appropriate rational to make a strong request using treatment guidelines. Most (not all) of my appeals go in my favor and some doctors are now using my system. If you need my help let me know.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#83
I am having difficulty sending you a private message. I will try back later.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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