Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
Calif UR doctors denying/Cashing out Medical. 1171
#11
(08-07-2017, 07:32 PM)Babebahn Wrote:
(08-06-2017, 06:49 PM)California_Help Wrote: So I asked this question to several applicant attorneys, if you can use Medicare after UR has denied medications.

First attorney responded yes, but the Medicare lien would have to be dealt with at the time of settlement. Another attorney stated just yes, and the third attorney stated an injured worker can step outside of the CA WC system and use private insurance or Medicare any time you want, even without a claim denial or UR/IMR denial and Medicare will place a lien. Again, I recommend calling Medicare and see what they tell you and go by that.
 I did contact Kaiser and Medicare. I do not have part D I only have Part A & B (hospital/medical) I asked about sending or Even bringing in my letters of denial to Medicare to see what they could do only to be told "I'm sorry we will not cover your medication prescribed by your pain management physician who is not part of Kaiser

Do you have both Kaiser (private insurance through employer or spouse) and Medicare (as secondary insurance), with Kaiser having prescription coverage? I was not aware when you wrote your post you did not have part D. I should not have assumed.
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.
 
Reply
#12
(08-08-2017, 10:55 PM)MCalifornia_Help Wrote:
(08-07-2017, 07:32 PM)Babebahn Wrote:
(08-06-2017, 06:49 PM)California_Help Wrote: So I asked this question to several applicant attorneys, if you can use Medicare after UR has denied medications.

First attorney responded yes, but the Medicare lien would have to be dealt with at the time of settlement. Another attorney stated just yes, and the third attorney stated an injured worker can step outside of the CA WC system and use private insurance or Medicare any time you want, even without a claim denial or UR/IMR denial and Medicare will place a lien. Again, I recommend calling Medicare and see what they tell you and go by that.
 I did contact Kaiser and Medicare. I do not have part D I only have Part A & B (hospital/medical) I asked about sending or Even bringing in my letters of denial to Medicare to see what they could do only to be told "I'm sorry we will not cover your medication prescribed by your pain management physician who is not part of Kaiser

Do you have both Kaiser (private insurance through employer or spouse) and Medicare (as secondary insurance), with Kaiser having prescription coverage? I was not aware when you wrote your post you did not have part D. I should not have assumed.
I only have prescription coverage with Kaiser. Medicare is my secondary.  No I do not have Part D Medicare coverage.
Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.
 
Reply
#13
(08-12-2017, 03:03 AM)Babebahn Wrote:
(08-08-2017, 10:55 PM)MCalifornia_Help Wrote:
(08-07-2017, 07:32 PM)Babebahn Wrote:
(08-06-2017, 06:49 PM)California_Help Wrote: So I asked this question to several applicant attorneys, if you can use Medicare after UR has denied medications.

First attorney responded yes, but the Medicare lien would have to be dealt with at the time of settlement. Another attorney stated just yes, and the third attorney stated an injured worker can step outside of the CA WC system and use private insurance or Medicare any time you want, even without a claim denial or UR/IMR denial and Medicare will place a lien. Again, I recommend calling Medicare and see what they tell you and go by that.
 I did contact Kaiser and Medicare. I do not have part D I only have Part A & B (hospital/medical) I asked about sending or Even bringing in my letters of denial to Medicare to see what they could do only to be told "I'm sorry we will not cover your medication prescribed by your pain management physician who is not part of Kaiser

Do you have both Kaiser (private insurance through employer or spouse) and Medicare (as secondary insurance), with Kaiser having prescription coverage? I was not aware when you wrote your post you did not have part D. I should not have assumed.
I only have prescription coverage with Kaiser. Medicare is my secondary.  No I do not have Part D Medicare coverage.
OK, now I clearer picture of your situation. Medicare will not cover this. When you state you only have prescription coverage with Kaiser, I assume you also have medical coverage to see a Kaiser doctor?

Can you go to a pain management doctor or even a general practitioner under Kaiser and tell them your situation, you were cut off and denied your medications through a paper UR review? Kaiser told you only a Kaiser doctors prescription will be covered. I am not familiar with Kaiser, only that other CA IW's have stated they were not treated very well and had difficulties getting treatment. Another idea would be to call Kaiser and ask their policy regarding denied treatment by work comp and ask for a copy of their policy. Some private health insurance companies also have nurses you can call when you need assistance.

If Kaiser refuses then you can try contacting this organization to see if you have rights under your private health insurer to cover these prescriptions. I have no idea if they do.
http://www.healthhelp.ca.gov/
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.
 
Reply
  


Possibly Related Threads...
Thread Author Replies Views Last Post
  How to get Lifetime medical enforced in CALIF Richard+Catz 2 1,044 11-30-2016, 06:26 PM
Last Post: California_Help
  cashing out on the medical bksmithson 4 1,084 07-14-2016, 08:52 PM
Last Post: California_Help
  401K contributions/ accruing PTO while out of work - CALIF kmecdd 8 1,733 02-21-2016, 11:46 PM
Last Post: California_Help
  P&S with a 30% wpi in Calif. ShatteredSurfer 1 3,165 03-06-2014, 06:09 PM
Last Post: 1171
  need advice Calif hmahalav 8 4,201 11-18-2013, 01:36 AM
Last Post: 1171
  SB 863 Calif. sl380mbz 6 4,790 06-21-2013, 02:47 PM
Last Post: sl380mbz
  Worker comp company wants to offer medical trust instead of lifetime medical benfits de88iet 1 7,379 10-20-2012, 12:36 AM
Last Post: 1171
  Shoulder Surgery on WC CALIF Debbysue64 8 8,918 12-01-2011, 05:45 PM
Last Post: LeglEgl
  CALIF 500k settlement 80k MSA what to do? CRY LADY 4 7,461 12-01-2011, 05:40 PM
Last Post: LeglEgl
  SSA Denying Settlement because of Worker's Comp cuwynicu 3 5,514 11-28-2011, 09:38 PM
Last Post: Bernie57

Forum Jump:


Browsing: 1 Guest(s)