[California_Help]

(02-02-2018, 08:46 PM)kibby Wrote:

(01-28-2018, 01:57 PM)California_Help Wrote: It would be helpful if you provided the name of medication and condition it is being prescribed for. 

I still think your claims adjuster should have run it through utilization review, unless the request was not sent on and RFA form, is for an injury that is not accepted OR has been previously denied by UR within the last 12 months. (JMO)

Well, now they just denied my Injections I was supposed to go but I had the appointment rescheduled due to another dr appointment. Good thing or else they would have been on the hook. They sent out the denial on the day I was supposed to have them. Thoracic, neck and lumbar injury is worthless with CIGA

I am surprised your doctor was going to do it without receiving an approval first. They may not have been on the hook if the denial was timely.

If you read your denial there should be two ways you or your doctor can appeal it. First through the internal UR appeal process and then through IMR. There are time limits with both. They should have stated why it was denied and the rational they used to deny it. Just FYI these are not always accurate and many times requests are denied due to lack of information. There are ways to appeal some of these denials (not always). If your doctor is well versed in WC he may know how to appeal this, but there are strict time limits.