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Final Notice from W/C Medication not covered
(01-24-2017, 06:56 PM)California_Help Wrote:
(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.
My adjuster said that since Peer Review states "there's no further review to appeal" it's basically closed issue... it doesn't look like they will overturn the situation. I'm schedule to see the physician again to figure out what next, I've started the weaning process and have developed palpitations but so far I'm ok.  This is a nightmare...I was ignorant in believing my Attorney when he said he would be there anytime, that lifetime medical meant I would never have trouble with medical treatment or payment.  So I think next week I will take a trip to WCAB and see if I can get some advise from someone.  Thanks for your advise.
Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.

Messages In This Thread
RE: Final Notice from W/C Medication not covered - Babebahn - 01-25-2017, 02:53 AM

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