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1171-Utilization Review Denial/Atty not actively representing
#11
They don,t want you as a patient.
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#12
Did you black out your attorney's info on the MAXIMUS form? If not they will notify your attorney and not you when to send relevant records. You can try to contact MAXIMUS and ask if they have sent this notification and if you can have it sent to you (if you did not black out your attorney's info on the IMR application).

I will tell you what is occurring in the real world with these UR and IMR denials. Doctors offices do not get paid to appeal UR denials and either do applicant attorney's. If you do not have a doctor who will appeal these, you can review your MPN and call from the list and ASK if the office appeals UR denials, if you want to change doctors. Again, I can try to help you appeal the denials on your own, but you will need your medical records. If your attorney is not representing you, you can ask for your file and this will be the easiest way to get them. I see no use having an attorney who is not helping you. If you represented yourself you would get copied on the medical reports.

Do you have alternative insurance or SSDI? You can usually use it when you get a denial from WC, but always check first.

Again, I can try to help you appeal these denials, but you need your medical records.
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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