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Has anyone successfully moved out of California with lifetime Medical?
#1
Hi, I have looked all over the Internet trying to figure out how to keep my "lifetime medical" outside California. Its bad enough finding good doctors in California who accept Workers Compensation rates and know the current law. What is the process if I were to move outside California to retain my medical treatment? I hear some IWs just use Medicaid or Medicare after failing to find doctors. Have you heard of any IWs that succeeded? Thank you for thinking about this question!
 
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#2
yes it can be very difficult and not all carriers will cooperate.
If your carrier uses an MPN, they have to have a written plan and should have options for treatment that include handling out of state care.
It's a public document and you can request a copy. they still have to cover treatment where there is no MPN available.
Generally The carrier should find you a new doctor or let you find one and they'll negotiate fee and specify reporting requirements to the out of state doc.
Do you have an atty and Will your atty Represent you with future medical issues?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
There are a few on this site who are having a lot of difficulty with getting medical treatment out of state. Your doctor will need to use a RFA form to make requests and also submit medical treatment guidelines under the CA work comp system, and let me be honest many of the doctors in California are struggling with submitting requests using these guidelines. I think it would be extremely difficult to get treatment due to that.
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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#4
(06-30-2017, 01:27 PM)California_Help Wrote: There are a few on this site who are having a lot of difficulty with getting medical treatment out of state. Your doctor will need to use a RFA form to make requests and also submit medical treatment guidelines under the CA work comp system, and let me be honest many of the doctors in California are struggling with submitting requests using these guidelines. I think it would be extremely difficult to get treatment due to that.



Thank you both for taking the time to evaluate my question, I've been in my office several times hearing people with regular insurance like Blue Cross, United Health and Aetna being told "We do not accept those insurances because their such a huge hassle"! I asked "What's it like with Comp or Medicare, Medicaid"? to my surprise "We would rather deal with Comp and Medicare than Big Insurance because they keep slashing our rates"! Do you know of any good Workers Compensation blogs, books or information I can teach myself because we are our best advocates? If anyone here has successfully moved from California to another State can you please PM me if your shy and explain how you transitioned? If not I understand, thank you all for being so kind!




My medications and doctors visits plus miles cost over $2000 per month, soon I will have double knee replacements and hip surgery yet the company refuses to offer anything. They send it to the UR every month, I fight a $15 per month medication with threats of using a IMR. You all know how foolish adjusters can behave, why would anyone decline a $15 a month generic while paying over $350 for a IMR? Thank you all again, hope you had a great 4th of July!
 
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#5
Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards. Carriers are required to enforce those provisions.
You didn't answer about your legal representation......

Yes, I do think you'd benefit by better information as to how the system has to operate.
the DWC website has link to resource material
http://www.dir.ca.gov/dwc/WC_referenceMaterials.htm

the guidebook is good for basic information for those with new claims
the physician's guide is a great source for those wanting an advanced understanding of the system.
both are linked at this DWC website
http://www.dir.ca.gov/dwc/dwcrep.htm
past research on specific topics can be found here
http://www.dir.ca.gov/chswc/chswc.html
and here
http://www.cwci.org/research.html

P.S. $15/month adds up fast over the many years a claim can be open.....
comp laws have to have the support of both the employers and the workers to stay on the books. Injured workers are only one of the stakeholders the legislature has to deal with.
In the mind of politicians as long as injureds and employer complaints cancel each out comp is fine.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#6
Too bad you didn't return for an answer; there's some very helpful information in those links.
I'm sure other visitors will be able to use them.. Thankx for the post.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#7
(07-05-2017, 11:29 PM)1171 Wrote: Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards. Carriers are required to enforce those provisions.
You didn't answer about your legal representation......

Yes, I do think you'd benefit by better information as to how the system has to operate.
the DWC website has link to resource material
http://www.dir.ca.gov/dwc/WC_referenceMaterials.htm

the guidebook is good for basic information for those with new claims
the physician's guide is a great source for those wanting an advanced understanding of the system.
both are linked at this DWC website
http://www.dir.ca.gov/dwc/dwcrep.htm
past research on specific topics can be found here
http://www.dir.ca.gov/chswc/chswc.html
and here
http://www.cwci.org/research.html

P.S. $15/month adds up fast over the many years a claim can be open.....
comp laws have to have the support of both the employers and the workers to stay on the books. Injured workers are only one of the stakeholders the legislature has to deal with.
In the mind of politicians as long as injureds and employer complaints cancel each out comp is fine.


Sorry, I am the sole caregiver for my mother with cancer, all the other kids want nothing to do unless its about money. I do have a lawyer that put my case in a box and offered me it back because he is retiring. So when I move its going to be up to me to do all the legal-paperwork. A worker can not miss a day for thirty plus years but once their injured your considered "trash" or basically a nuisance they do not want to pay for.


All the medications I get are backed by going to three doctors every month, I heard about one IW who fly's back to California every three months to get his medication refills. While waiting for my doctor I heard someone call in to get seen, they said "we are not taking any new patients, only insurance we accept is Medicare and Workers Compensation, no Blue Cross or Big Carriers because they got ripped off.


Its hard enough to get five minutes with our doctors, imagine trying to get them to RFA our medications. I read through those links, moving out of State is really hard for someone on WC. Its been almost 20 years battling this crap, I started my job at 15, had massive amount of weight fall on my back destroying it. I apologize for not replying sooner, I wish my adjuster would settle the case but they refuse. Thank you!
 
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#8
(07-11-2017, 06:36 PM)TreadingWater Wrote:
(07-05-2017, 11:29 PM)1171 Wrote: Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards. Carriers are required to enforce those provisions.
You didn't answer about your legal representation......

Yes, I do think you'd benefit by better information as to how the system has to operate.
the DWC website has link to resource material
http://www.dir.ca.gov/dwc/WC_referenceMaterials.htm

the guidebook is good for basic information for those with new claims
the physician's guide is a great source for those wanting an advanced understanding of the system.
both are linked at this DWC websiteTreadingWater
(07-05-2017, 11:29 PM)1171 Wrote: Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards.
http://www.dir.ca.gov/dwc/dwcrep.htm
past research on specific topics can be found here
http://www.dir.ca.gov/chswc/chswc.html
and here
http://www.cwci.org/research.html

P.S. $15/month adds up fast over the many years a claim can be open.....
comp laws have to have the support of both the employers and the workers to stay on the books. Injured workers are only one of the stakeholders the legislature has to deal with.
In the mind of politicians as long as injureds and employer complaints cancel each out comp is fine.


Sorry, I am the sole caregiver for my mother with cancer, all the other kids want nothing to do unless its about money.  I do have a lawyer that put my case in a box and offered me it back because he is retiring.  So when I move its going to be up to me to do all the legal-paperwork.   A worker can not miss a day for thirty plus years but once their injured your considered "trash" or basically a nuisance they do not want to pay for.  


All the medications I get are backed by going to three doctors every month, I heard about one IW who fly's back to California every three months to get his medication refills.   While waiting for my doctor I heard someone call in to get seen, they said "we are not taking any new patients, only insurance we accept is Medicare and Workers Compensation, no Blue Cross or Big Carriers because they got ripped off.


Its hard enough to get five minutes with our doctors, imagine trying to get them to RFA our medications.  I read through those links, moving out of State is really hard for someone on WC.  Its been almost 20 years battling this crap, I started my job at 15, had massive amount of weight fall on my back destroying it.  I apologize for not replying sooner, I wish my adjuster would settle the case but they refuse.  Thank you!
Going to 3 doctors a month just to back up what is needed for medication refill sounds tiring. I hop one of them is a good pain management doctor.

If you click the link and see what an RFA form looks like, it is a very simple easy for to fill out. In my opinion, it is not these forms that you will have some problems with, instead it is the medical treatment guidelines expected in the CA work comp system is what your doctors will not want to deal with (out of state doctors). You can look up these guidelines yourself, and I have developed a fairly easy system how to do this. I think you will need to know the guidelines, rational needed for your medications otherwise the insurance company may try to deny them. If you are on Medicare and get a denial through work comp you should be able to use Medicare, just alert them of the denial.

Every state is different as far as what is going on with pain medications.
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
#9
(07-11-2017, 07:25 PM)California_Help Wrote:
(07-11-2017, 06:36 PM)TreadingWater Wrote:
(07-05-2017, 11:29 PM)1171 Wrote: Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards. Carriers are required to enforce those provisions.
You didn't answer about your legal representation......

Yes, I do think you'd benefit by better information as to how the system has to operate.
the DWC website has link to resource material
http://www.dir.ca.gov/dwc/WC_referenceMaterials.htm

the guidebook is good for basic information for those with new claims
the physician's guide is a great source for those wanting an advanced understanding of the system.
both are linked at this DWC websiteTreadingWater
(07-05-2017, 11:29 PM)1171 Wrote: Cal comp & Medicare both have fee schedules and will cut overcharges.
Medical benefits have to be due because of the work injury and also meet objective treatment standards.
http://www.dir.ca.gov/dwc/dwcrep.htm
past research on specific topics can be found here
http://www.dir.ca.gov/chswc/chswc.html
and here
http://www.cwci.org/research.html

P.S. $15/month adds up fast over the many years a claim can be open.....
comp laws have to have the support of both the employers and the workers to stay on the books. Injured workers are only one of the stakeholders the legislature has to deal with.
In the mind of politicians as long as injureds and employer complaints cancel each out comp is fine.


Sorry, I am the sole caregiver for my mother with cancer, all the other kids want nothing to do unless its about money.  I do have a lawyer that put my case in a box and offered me it back because he is retiring.  So when I move its going to be up to me to do all the legal-paperwork.   A worker can not miss a day for thirty plus years but once their injured your considered "trash" or basically a nuisance they do not want to pay for.  


All the medications I get are backed by going to three doctors every month, I heard about one IW who fly's back to California every three months to get his medication refills.   While waiting for my doctor I heard someone call in to get seen, they said "we are not taking any new patients, only insurance we accept is Medicare and Workers Compensation, no Blue Cross or Big Carriers because they got ripped off.


Its hard enough to get five minutes with our doctors, imagine trying to get them to RFA our medications.  I read through those links, moving out of State is really hard for someone on WC.  Its been almost 20 years battling this crap, I started my job at 15, had massive amount of weight fall on my back destroying it.  I apologize for not replying sooner, I wish my adjuster would settle the case but they refuse.  Thank you!
Going to 3 doctors a month just to back up what is needed for medication refill sounds tiring. I hop one of them is a good pain management doctor.

If you click the link and see what an RFA form looks like, it is a very simple easy for to fill out. In my opinion, it is not these forms that you will have some problems with, instead it is the medical treatment guidelines expected in the CA work comp system is what your doctors will not want to deal with (out of state doctors). You can look up these guidelines yourself, and I have developed a fairly easy system how to do this. I think you will need to know the guidelines, rational needed for your medications otherwise the insurance company may try to deny them. If you are on Medicare and get a denial through work comp you should be able to use Medicare, just alert them of the denial.

Every state is different as far as what is going on with pain medications.


Thank you so much for being so kind, the adjuster decided to stop my psyche medications "cold turkey" and this is while I am living in California still. Internet is such a God Send with big heart, kind people like you willing to help out strangers. Driving to three doctors every month gets the adjuster angry because she writes out a check for $2500 in mileage every year. The pharmacy I have to get my medications from tells me they are there only to have me drive 30 miles each direction finding no medications. Should I go to the ER since the adjuster refused filling my psyche and nerve pain medications?
 
Reply
#10
Sometimes other health insurers will cover services denied by workers comp.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
  


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