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California - Lifetime Med - Coverage Terminated
#3
Sorry I cannot edit my post. I meant to write there are many reasons why medication is not refilled in the California work comp system.

1. Pharmacy did not get a response or approval from the claims adjuster as it was still being reviewed and pharmacy took this as a denial. Asking the pharmacist to run the request again usually resolves this.
2.Doctor did not send in the request on a RFA form.
3. Doctors office never sent in the request for refill.
4.Request was denied by UR and doctor did not appeal it through the internal UR process or through the IMR process.
5. Medications were denied due to medications previously being denied within a 12 month period without a change of condition or material facts known.
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: California - Lifetime Med - Coverage Terminated - California_Help - 01-23-2019, 11:36 AM

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