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Final Notice from W/C Medication not covered
Hi Everyone: Sorry for being a pest, but let me tell you, I'm sharing this with you for a Heads Up!  I received a packet from W/C with big bold letters "FINAL NOTICE"  here's the letter:
Please be aware that this letter serves as our final notice as it relates to the payment of the following medications "Norco/Tizanidine (Zanaflex) for the injured worker "ME" on 12/19 the aforementioned medications were denied via utilization review, expert reviewer report is attached for reference... There are no further options available for appeal! On 1/11/2017 our pharmacist provided a suggested weaning protocol for your review and consideration.  In addition, I have called your office on 2 different occasions regarding this issue and I have sent same number of follow up letters to your office and the Applicants Attorney in regards to this denial determination along with the date at the which the medications will no longer be covered workers compensation.  Please be aware that stating on 2/15/2017 the medication Norco/Tizanidine (Zanaflex) will no longer be paid for by workers compensation.

I saw my Doctor on 1/13/2017, we discussed the recent noticed of 12/20/2016 I sent in my DWC IMR for review, I even faxed it to my my adjustor.  I spoke to the adjustor this afternoon and she was shocked I got a "final notice"  "you're the first client I know who has ever received a final notice" she suggested I contact my doctor and find out what medication he will recommend.  This is because of the new California Work Comp Opioid Analgesic Treatment Guidelines Aug 2016.
What the heck am I suppose to do? Start the weaning process of a medication which could cause a palpitations/heart attack during the "weaning/withdrawal process" This is terrible... So much for lifetime medical without any problems... well that's what my attorney told me during the Settlement Conference and signing!
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.

Messages In This Thread
Final Notice from W/C Medication not covered - Babebahn - 01-23-2017, 08:25 PM

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