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Final Notice from W/C Medication not covered
#6
(01-23-2017, 08:41 PM)Babebahn Wrote:
(01-23-2017, 08:33 PM)1171 Wrote: treatment denied by work comp is often available thru your general health insurance.

My private insurance isn't going to pay for it because its a work comp issue according to my PCP

Ask your PTP for a prescription and then take it to your pharmacy and tell them to bill your private insurance. If you get a denial from your private insurance, you will be the first on this site I have seen.

I assume you have not received the IMR determination yet? You may still get this over turned by IMR, but to do that you or your doctor should have sent relevant medical treatment guidelines and records that show the request is warranted. Often times patients conditions do not fall under the guidelines they listed. Review the UR denial completely and look for inaccuracies or if your condition does not fall under the BS or umm guidelines they used. Have you discussed with your doctor and did he help with your IMR?

If you receive or received a IMR denial make sure you review that and the UR denials. Often times relevant records were not sent and that can be grounds for your doctor to make the request again and/or if you have a substantial change in condition this may also be ground to make a request again, before the 12 month waiting period.

If you go into withdrawals go to the emergency room and give them your work comp claims info to bill Do not put yourself in that situation. Ask your doctor what to do, but in my opinion you should be able to use your private insurance once denied by work comp. If in doubt call your private insurance and ask.
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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RE: Final Notice from W/C Medication not covered - California_Help - 01-24-2017, 06:56 PM

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