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PTP recommends Pain Doctor
#1
Hi Folks 

California Claim here : My Ortho PTP Has referred me to a Pain Management Specialist .. Unfortunately I have heard nothing regarding the matter.

Would this be the same process as an RFA subject to UR and IMR ?

How is this supposed to work ?  I know the new PM Doc will  need authorization first. Seems like that's the hold up.

Before I start making calls, I want to have an understanding of this process . This way I can pinpoint a problem if one exist. Definatley don't want to say the request was ignored because I don't know that either.

Any thoughts  ? just want to cure or find relief for the medical problem.

Thanks 

Shadow
 
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#2
make an apt with the pain doc . let them get approval.
they;l tell you if there's a problem.
if the doc is in the MPN, it should not be an issue.
Reminder :
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THANKS FOR POSTING.
 
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#3
(10-05-2016, 02:25 AM)Shadow Wrote: Hi Folks 

California Claim here : My Ortho PTP Has referred me to a Pain Management Specialist .. Unfortunately I have heard nothing regarding the matter.

Would this be the same process as an RFA subject to UR and IMR ?

How is this supposed to work ?  I know the new PM Doc will  need authorization first. Seems like that's the hold up.

Before I start making calls, I want to have an understanding of this process . This way I can pinpoint a problem if one exist. Definatley don't want to say the request was ignored because I don't know that either.

Any thoughts  ? just want to cure or find relief for the medical problem.

Thanks 

Shadow
This can go several ways and sometimes there can be roadblocks getting to a secondary treater:

It has to be recommended on a RFA form from your treating doctor, just like his other requests but this is for a specialist referral. Do you know if your doctor made a blanket request or picked a pain management doctor within your MPN? If he did not pick one you may get an approval but you will most likely need a letter from your adjuster stating the doctors name is approved, however some doctors will take a UR approval without their name. if this happens and you have an attorney, he can usually contact your adjuster if you need a letter.

How long has it been since he requested it? The only way you will know is to ask your treating doctors office for a copy of the RFA and fax  or mail confirmation sheet. You can wait until your next appointment or go down to their office. Sometimes doctors do not send out the RFA until their report is transcribed. You probably have a good idea of how long it takes for your doctors office to send requests. Your claims adjuster can approve or send to UR 5 business days total and if UR needs more information up to 14 days. The day sent does not count and you have to add 5 business days if mailed on top of the 5-14 days for UR to respond.

If your claims adjuster approved the request and did not sent to UR she may have sent your requesting doctor an approval, again you need to review the RFA and fax/mail confirmation form or wait until you see your primary treating doctor.
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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