Legal Question in Workers Comp in California
Prescription....
My Doctor,Prescribed a Theraputic Bed, for My Back. Comp Partners Denied the Prescription. 1, They Said the could'nt Reach My Doc for More Info. 2. They Said it was for Comfort than Medical. My can or should My Doc appeal??? and Does the Insurance need to Comply
2 Answers from Attorneys
Re: Prescription....
If it is absolutely necessary and it is an acceptable treatment. Of course insurance company utilization review procedure denies that they are necessary and accepable treatment. I recommend to utilize an unbiased QME or AME to move your case forward. Then the insurance company gets stuck with recommendation of such evaluators. Call us at 213.388.7070 for a free consultation.
Re: Prescription....
The U.R. can deny any treatment. In order to properly object to the U.R., you must first determine whether or not the U.R. is valid. There are a list of factors which must be considered. E.g.; was the U.R. determination timely? Did an M.D. make the determination?, etc.
The doctor can appeal the decision, but the above factors, plus other factors not listed above must be considered for a successful objection.
Please feel free to contact my office at 818.385.0520 to discuss this matter further.
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