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

Thread Rating:
  • 1 Vote(s) - 5 Average
  • 1
  • 2
  • 3
  • 4
  • 5
medical release/buyout? and/ or fight for medical ongoing
#41
Hello, I hope you are all well. This is the best support I have in getting my mind wrapped around this WC system in order to be treated fairly and not wear my atty out as there are many battles we are fighting. I wanted to share I have won one important battle yesterday in regards to the medication issue. I had my prescription processed just the way your feedback advised and this is the first time in over 6 months I did not pay for my meds. Thank you for informing me about the RFA form as my pain management doctor's personnel faxed the RFA form for authorization for my prescription and it was authorized within5 business days. This may not seem like a big issue to some but it has been and an expensive one. Hopefully the pending appeal on my other issues will go well as my medical circle is putting together the information previously provided, certified after peer-to-peer talk another MD called and overrode the previous MD, then certifications denied. Additionally, the 18 certified visits I had they are refusing to pay the MD. I believe in what you said about the judge not allowing the defense to continue with non-compliance and there is no reason to go to trial for a few $'s when all they have to do is provide verification of the accounting which the judge had the 2 attys do in Jan 2014 and agreed. Agreed it still appears to be an underpayment so I look at it as a high interest bearing savings account. July is around the corner. I am putting together a synopsis of the info to have a discussion with my atty for the medical buyout after the underpayment and medical necessity appeals are done and I speak to an ERISA atty. I have been thinking if I go on and retire in appx 9 months with 40 years and I am not entitled to social security can the medical buyout affect my retirement income as it may possibly affect the LTD? My atty mentioned that the defense may want me to retire anyway as part of the buyout agreement, I am having to fight for 2 1/2 years of service credit currently before I retire anyway. Winning the prescription medicine battle was rejuvenating and relieving as to the stress I was unnecessarily going through. Thank you. Sahshah
 
Reply
#42

I am SO happy you received your medications.

I am a little confused on your current appeal situation. If UR approved the request, did the UR company send it to another UR doctor and he denied it right afterward?

I do not know about your retirement situation. I would suggest talking to someone about this before you agree to a settlement, just like your LTD situation.

Is your attorney still going to take the owed monies to court again?

I am glad getting your prescriptions has relived some of your stress. It sounds like everything is coming to a resolution for you and hopefully it will all go well for you.
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
#43
Thank you.
The appeal for my acupuncture treatments and yes they did, the first UR DR. approved and the company did get another DR to deny right after, my PTP called backto no avail, appeal pending. They stopped the remaining and new certified ones and have not paid for the treatments that were certified and completed,
Atty is going to follow through for the underpaid monies, we have a court date for July and the judge told defense no more refusal to provide the accounting or trial will start. I do not see them wasting time in a trial for a 10K u/p, but I never thought such an easy settlement would have made all this easier and it got worse. We shall see, I definitely will not stress about it and will inform myself wirh the ERISA atty or retire then do medical.
We shall see. Thank you very much. Have a good day. Sahshah
I
 
Reply
#44

If your doctors office sent in another request by accident right after the first one, then I can see where this situation can happen. This can also happen when you have two treating doctors who request the same thing. If you find out one of these scenerios is the case, again this may be able to get resolved with a phone call. The doctors office should be the one's getting this resolved and can also call the UR company. I see a lot of things linger that can sometimes be resolved with a phone call. It sounds like your doctors office is working on this.

Good luck on your upcoming court date.
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
#45
http://leginfo.legislature.ca.gov/faces/...20160SB563

Sahaha, Your story about the struggles you have had receiving the medical treatment agreed to in your stip with open medical is why I am trying to spread the word about SB563. This bill states injured workers in California who have stipped their claims with open medical with a future medical award agreeing to specific treatments will not have these treatments sent through UR unless they have a change of condition.

The DWC has made a public statement that IC's should not be sending medications through UR as a cost containment tool and should not be used unless there is a change in condition. I agree, but there is no current rules to enforce this.

If injured workers were more proactive with the laws in their states, I believe this system could be greatly improved. It only takes a few minutes to call your representative, or write a letter. Many people do not know you can make an appointment to meet with your representative to discuss a bill. If they are not available you can meet with one of their assistants. Meeting with your representatives over issues such as a bill that is important to you can develop a relationship. This is what the insurance lobby is doing. They are calling, writing and meeting with YOUR representatives. We can do this as well.

To find out who are the representatives by your address, you can get their contact info here.
http://findyourrep.legislature.ca.gov/

I hope California injured workers reading this link, will take 5 minutes to read SB563 which I provided above, and if you support this bill let your representatives know it and ask they support the SB563 with their vote.
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
  And The Fight Begins.... NY tbear6410 41 3,259 09-07-2019, 08:07 PM
Last Post: California_Help
  Medical set-aside inquiries Andy1689 4 592 09-04-2019, 12:45 AM
Last Post: 1171
  settlement with open medical Andy1689 2 470 08-25-2019, 02:54 PM
Last Post: 1171
  Medical set aside redsoxfan 21 1,367 08-11-2019, 03:07 PM
Last Post: 1171
  Maximum Medical Improvement lovemygirls02 9 1,027 08-10-2019, 05:48 PM
Last Post: Turtle23
  open medical pros and cons freebird 23 33,342 07-08-2019, 09:27 PM
Last Post: Bets
  Leaving your medical open Bets 6 973 07-08-2019, 01:47 PM
Last Post: adkreb
  New claim in Massachusetts, do I sign Medical Authorization Release Form??? spoe.eops 3 367 05-30-2019, 09:21 PM
Last Post: 1171
  Workers Comp Disputing Medical Bills gamora77 1 687 03-15-2019, 11:22 PM
Last Post: 1171
  Lifetime medical payout Jerry_Rivera 2 628 03-12-2019, 11:04 AM
Last Post: 1171

Forum Jump:


Browsing: 1 Guest(s)