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Claims adjuster now ignoring my doctor
#1
My doctor made two requests for treatment backed up by specific pr2's, 1 being 4 my 3rd mri, and my claims adjuster just ignored them. Both are well past 5 and 15 day UR review limits. Also ignoring paying my mileage but thats chump change. Do i have to file for expedited hearing or is there more immediate way to handle this?

Claim in CA,

Thanx

 
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#2
you can self-procure or have your health care provider approve and seek later reimbursement from comp.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(02-14-2012, 05:55 PM)AxedmyAtty Wrote: My doctor made two requests for treatment backed up by specific pr2's, 1 being 4 my 3rd mri, and my claims adjuster just ignored them. Both are well past 5 and 15 day UR review limits. Also ignoring paying my mileage but thats chump change. Do i have to file for expedited hearing or is there more immediate way to handle this?

Claim in CA,

Thanx

I WOULD FILE AN ONLINE COMPLAINT WITH THE STATE DEPT OF INSURANCE.

 
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#4
Regarding the treatment, failure to respond is the same as authorizing the treatment. Assuming they aren't even responding, they've taken away their ability to object. One caveat though, is that if the requests are essentially the same thing and nothing is changed, then a previous UR would probably still be valid.

How long have you been waiting for a mileage reimbursement? There is a fairly long timeline for that.

You could file for hearing and request 5814 penalties for unreasonable delay, just make sure you're right first.
 
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