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CA-UR Denials for every scrip
#11
(01-08-2014, 12:47 AM)SickOfTheProcess Wrote: IC is just started denying every scrip my pain management doc has been writing for months. Each and every scrip was sent to UR review and subsequently denied. Now I must appeal each one through CA wonderful IMR review process.

Why on earth would an adjuster deny a $50 scrip that's going to cost them $530 in IMR review is beyond me. Is this now the tactics others are seeing in CA to deny access to treatment and medications by claims adjusters?

Sure does seem to be a way to deny all care to workers since it can take months to get a decision on a denied UR review via IMR. I have been waiting since July for a decision on a cervical ESI.

Is your adjuster allowing refills for the UR denied medications awaiting an IMR or just making you suffer?

If not you can try this company. They do medications on liens. Ask your attorney first before attempting.

http://www.buenavistarx.com/3.html
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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#12
Ive been in CA WC since 2000 with a spine injury. I've just gotten my first request for review to stop my pain meds, trying to understand my options.

What are the consequences of using my wife's work provided insurance to pay for my meds while on the appeals processes?




(01-08-2014, 12:47 AM)SickOfTheProcess Wrote: IC is just started denying every scrip my pain management doc has been writing for months. Each and every scrip was sent to UR review and subsequently denied. Now I must appeal each one through CA wonderful IMR review process.

Why on earth would an adjuster deny a $50 scrip that's going to cost them $530 in IMR review is beyond me. Is this now the tactics others are seeing in CA to deny access to treatment and medications by claims adjusters?

Sure does seem to be a way to deny all care to workers since it can take months to get a decision on a denied UR review via IMR. I have been waiting since July for a decision on a cervical ESI.

 
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#13
(12-11-2014, 07:04 PM)Robert68 Wrote: Ive been in CA WC since 2000 with a spine injury. I've just gotten my first request for review to stop my pain meds, trying to understand my options.

What are the consequences of using my wife's work provided insurance to pay for my meds while on the appeals processes?




(01-08-2014, 12:47 AM)SickOfTheProcess Wrote: IC is just started denying every scrip my pain management doc has been writing for months. Each and every scrip was sent to UR review and subsequently denied. Now I must appeal each one through CA wonderful IMR review process.

Why on earth would an adjuster deny a $50 scrip that's going to cost them $530 in IMR review is beyond me. Is this now the tactics others are seeing in CA to deny access to treatment and medications by claims adjusters?

Sure does seem to be a way to deny all care to workers since it can take months to get a decision on a denied UR review via IMR. I have been waiting since July for a decision on a cervical ESI.



They stopped my meds a long time ago, now I take my scripts to my lawyet. He gets them filled then bills wc, it does take longer to get, but I get them. U might want to ask ur lawyer if he can that.
 
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#14
(12-11-2014, 07:04 PM)Robert68 Wrote: Ive been in CA WC since 2000 with a spine injury. I've just gotten my first request for review to stop my pain meds, trying to understand my options.

What are the consequences of using my wife's work provided insurance to pay for my meds while on the appeals processes?




(01-08-2014, 12:47 AM)SickOfTheProcess Wrote: IC is


They should continue to refill during the appeal process. If not you should be able to use private insurance, but I suggest contacting your private insurance about it If it is denied you should be able to use it.

I would jump on the appeal process ASAP. You have a short window. I suggest calling your doctors office and ask them to appeal the UR denial. Do you have an attorney? If not you can begin the IMR process as well.

Look at the reason for the UR denial and if you can provide records to overturn the UR denial, give them to your doctor to send with the UR appeal. This is my suggestion.

You have two chances to appeal this. You can do a UR appeal and then do an IMR request. If both get denied, if you have a change in condition without the medications, this may be grounds to request it again before the 12 month waiting period.

Let me know if you have any questions about the appeal process. It can be confusing, and I can walk you through it. If your doctor does not do UR appeals, you can also appeal it, and I can help you with it if you need my help.

California_help
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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#15
If they don't pay for the meds during the appeal process, and we pay out of pocket, will we be reimbursed if we are approved, after the appeal.
 
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#16
There is a new case by the way that questions running EVERY prescription through UR EVERY month. It states only if there is a change in condition should medications be run through UR AFTER they have already been approved. This is clearly doctor shopping and an abuse of the system, not to mention to the IW.Just wanted to add this as it is relative to the beginning posts in this string.

I see California applicants attorney's are now pushing back, post SB863. Better late than never is what I say.

http://www.workerscompzone.com/2014/11/22/mccool/

Here is another good read for California injured workers...

http://www.workerscompzone.com/2014/12/1...t-granted/

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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