How can you say the system is working if it has a 95% approval rate?
That means that either the process is too lenient, or there never was a problem to begin with.
From the experience of working in a doctor’s office, I can tell you the program works great for the insurance companies. Try getting pre-authorization to treat a WC’s client. Your first stumbling block is just trying to get a claims adjuster to respond to your paperwork and follow up calls. If you get authorization and that’s a BIG if, it does not mean the doctor will actually get paid. According to the claims adjust its up to the utilization adjuster to determine whether or not the care was necessary. If utilization decides it’s not necessary, the doctor does not get paid.
Try telling a WC’s patient in pain ‘gee, I’d really like to treat you but I have to wait until I get authorization from your adjuster’ that just happens to not respond to your faxes or calls. While any of the 70,000 IMR cases are being reviewed, a good percentage of the people that submitted these cases are in pain and not being treated. The fact that 70,000 cases exist certainly suggest a large percentage of WC’s patients are being left to fend for them while their case are under review. If you’re in need or care or in chronic pain, any wait is too long.
The system is not working. There needs to be transparency for all parties, and accountability. We need to stop thinking that everyone is trying to “work” the system. Doctors have to be trusted to provide reasonable standard of care. Turn around times have to be required for utilization review and approval. Patients have to contact their legislative representatives to insist on better care.
In one of Malcolm Gladwell’s books, he talks about how much money was sent on the healthcare of an alcoholic, homeless man. For the same amount of money, he, and 50 others, could have been put up in apartments, food stamps and had routine healthcare. But in all our country’s wisdom, we are handling this backwards. If a worker is injured, let him go anywhere to get treatment. Now with the Affordable Care Act, workers comp should change. If you get injured, you are not a bad person!!!
The system is not even close to working. The only way that it is working is for the insurance companies railroading the injured worker. I am one of those injured workers I got injured 1-11-1985 and have been disabled ever since. I have had four surgeries with instrumentation and I have other levels that will need attention in the future. I now live by doing what ever I can and as much as I can until the pain stops me, I do this by taking Pain pills If I did not take them I would not move at all. I signed A findings an award Thirty five years ago that gave me life time medical for my back injuries and now they are saying that does not matter. I think that is fraud and what does that make a contract worth and or mean (nothing) This Is wrong and immoral and I have had to fight this since the beginning and I guess I will Die fighting it.
I was injured on 8-25-2000. I had bulging disc’s L4-L5. Had a microdisketomy, then proceeded to have Sciatica since that surgery 14 years ago. Now come forth 2013, muscle spasm at thoracic left side??? Huge, painful spasms that enable me from walking to the mailbox 3 doors down. MRI now shows that I have significant Scoliosis ..never had it before. AIG refuses now through the IMR process to pay for any analgesics, pain meds, on Norco, Methadone, Zoloftm, Valium for 14 years now. Oh, and segmental collapse of the lumbar spine and Spondylosis as well. My teeth have been decaying from Xerostomia and have spent $90,000.00 out of pocket expenses, NOT reimbursed for any. In the end 13 years later my C&R was medical for my back, dental, phsyche, leg, and upper extremeties for the Carpal Tunnel I contracted as a result of my “re-training” 18 college units of ComputerCourses. The IMR Process has denied ALL MEDS, ALL DENTAL, ALL TRIGGER POINT INJECTIONS.. they will however pay for DETOX and a Spine Stimulator or Spinal Fusion… so I think… I am not crippled and twisted from the Scoliosis and my 70 year old mother had to move in to take care of me. PAthetic no? My adjuster is an outright jerk,my Pain Management MD, can never seem to respond to ANY of his UR peers in response to the treatment he requested. It then goes to the UR board with no comment from my MD and my atty file for the IMR which has always ended in NO>>> You cant have that either! Despite the obvious pathology on the MRI, CT, EMG, and dental reports of the worst case of Xerostmia ever seen. I do not understand how the judge AWARDED ME for these body parts only to have the UR and the IMR process deny ALL TREATMENT since we settled the case, oh and the smal;l amount of cash I recieved was paid to the attorney and my in-laws for the $60,000 in dental loans over the past 10 years.
NO, sorry, the process is not working, I have been denied 100% of the 18..yes.. “eighteebn” UR/IMR reviews. I would like to know how to get help, as I cannot seem to find an attorney with any DESIRE to help the injured worker.
Thanks for the therapy ..as they denied that as well.
JB.
There is a problem with the new laws, and cannot comply especially with old injuries. There should be a clause for the old cases and medical that is promised. UR should not touch the old cases that have already been tried and tested with the AME, IME, QME and now after all these years, a new law comes into play and nothing is covered anymore, as was promised and also put into law.
During all of this new law making, sweeping everyone into this viscous cycle and one size fits all just cannot work. It creates victims and depression, and will most likely be responsible for the deaths of some.
Work Comp and the laws made by the Insurance companies who obviously paid the legislation with favors, have created a pure evil system, and all doctors who work for them have sold their souls and the oath they took, is long forgotten.
I’ve been told that WC suicides are very high. I certainly believe it. I’ve contemplated doing it myself because of meds being denied. CA Workers’ Comp is absolutely horrible, unjust, unfair and worthless except for the lawyers and “3rd party medical reviewers.”
I work in the work comp industry and I can tell you that this system most certainly is NOT working. For a 100% disabled claimant that has chronic pain, with lifetime medical, to be completely cut off of all medications, any physical therapy, any and all modalities of treatment and be forced to go through Medicare to get their medications is just ridiculous. These people just want to function and now CMS is going to be further in debt due to people with chronic pain having no other option than to go through Medicare. I would like to speak to the people that did this analysis and give them my full opinion on the matter. It’s not pretty.
Medicare won’t cover anything that has to do with a Workers’ Comp injury.
A few years ago I received a letter from Medicare claiming that my family doctor had charged them for a Workers’Comp injury. Several months later I received a bill from Medicare to reimburse them for the (erroneous) charge plus interest.
Fortunately my doctor straightened it out with them or I (not the doctor) would have had to pay Medicare over $4,000.00, which I don’t have being that I’m unable to work and only collecting a very small fixed income from Social Security.
A few years ago I received a notification from Medicare that my personal doctor charged them for something that should have been billed to Workers’ Comp. Several months later I received a bill from Medicare for that charge.
Fortunately my doctor straightened it out with Medicare or I (not the doctor) would have had to repay Medicare over $4,000.00 plus interest added monthly.
CA Workers’ Comp is not working for the injured worker. It’s a total scam where meds, treatment, surgeries, etc are denied and there’s nothing the injured worker can do about it. Our government has betrayed the CA injured worker and it all benefits the employer and ins companies. I know of a Workers’ Comp executive who wouldn’t file a claim for their on-the-job injury because they know how corrupt and unfair the system is. Better they pay for their medical care on their own and not have this on their record. My meds have been denied and changed numerous times, despite the fact that my doctor of 15 yrs has given evidence of why the meds are needed for my serious spinal injury. May God do to these rotten people as they have done to us only much greater.
How can you say the system is working if it has a 95% approval rate?
That means that either the process is too lenient, or there never was a problem to begin with.
THIS LADY DID NOT SEEM TO DARN HAPPY WITH IT http://www.youtube.com/watch?v=U2cVHNqFkQA
From the experience of working in a doctor’s office, I can tell you the program works great for the insurance companies. Try getting pre-authorization to treat a WC’s client. Your first stumbling block is just trying to get a claims adjuster to respond to your paperwork and follow up calls. If you get authorization and that’s a BIG if, it does not mean the doctor will actually get paid. According to the claims adjust its up to the utilization adjuster to determine whether or not the care was necessary. If utilization decides it’s not necessary, the doctor does not get paid.
Try telling a WC’s patient in pain ‘gee, I’d really like to treat you but I have to wait until I get authorization from your adjuster’ that just happens to not respond to your faxes or calls. While any of the 70,000 IMR cases are being reviewed, a good percentage of the people that submitted these cases are in pain and not being treated. The fact that 70,000 cases exist certainly suggest a large percentage of WC’s patients are being left to fend for them while their case are under review. If you’re in need or care or in chronic pain, any wait is too long.
Really one of the awesome post about California Workers’ Comp IMR Working.Thanks for the awesome information about that.
Thank you, Diana C. You’re absolutely right!
And we “victims” can thank our ex-governator for starting this. I fear what’s coming next, or rather what will be eliminated next!
The system is not working. There needs to be transparency for all parties, and accountability. We need to stop thinking that everyone is trying to “work” the system. Doctors have to be trusted to provide reasonable standard of care. Turn around times have to be required for utilization review and approval. Patients have to contact their legislative representatives to insist on better care.
In one of Malcolm Gladwell’s books, he talks about how much money was sent on the healthcare of an alcoholic, homeless man. For the same amount of money, he, and 50 others, could have been put up in apartments, food stamps and had routine healthcare. But in all our country’s wisdom, we are handling this backwards. If a worker is injured, let him go anywhere to get treatment. Now with the Affordable Care Act, workers comp should change. If you get injured, you are not a bad person!!!
The system is not even close to working. The only way that it is working is for the insurance companies railroading the injured worker. I am one of those injured workers I got injured 1-11-1985 and have been disabled ever since. I have had four surgeries with instrumentation and I have other levels that will need attention in the future. I now live by doing what ever I can and as much as I can until the pain stops me, I do this by taking Pain pills If I did not take them I would not move at all. I signed A findings an award Thirty five years ago that gave me life time medical for my back injuries and now they are saying that does not matter. I think that is fraud and what does that make a contract worth and or mean (nothing) This Is wrong and immoral and I have had to fight this since the beginning and I guess I will Die fighting it.
I was injured on 8-25-2000. I had bulging disc’s L4-L5. Had a microdisketomy, then proceeded to have Sciatica since that surgery 14 years ago. Now come forth 2013, muscle spasm at thoracic left side??? Huge, painful spasms that enable me from walking to the mailbox 3 doors down. MRI now shows that I have significant Scoliosis ..never had it before. AIG refuses now through the IMR process to pay for any analgesics, pain meds, on Norco, Methadone, Zoloftm, Valium for 14 years now. Oh, and segmental collapse of the lumbar spine and Spondylosis as well. My teeth have been decaying from Xerostomia and have spent $90,000.00 out of pocket expenses, NOT reimbursed for any. In the end 13 years later my C&R was medical for my back, dental, phsyche, leg, and upper extremeties for the Carpal Tunnel I contracted as a result of my “re-training” 18 college units of ComputerCourses. The IMR Process has denied ALL MEDS, ALL DENTAL, ALL TRIGGER POINT INJECTIONS.. they will however pay for DETOX and a Spine Stimulator or Spinal Fusion… so I think… I am not crippled and twisted from the Scoliosis and my 70 year old mother had to move in to take care of me. PAthetic no? My adjuster is an outright jerk,my Pain Management MD, can never seem to respond to ANY of his UR peers in response to the treatment he requested. It then goes to the UR board with no comment from my MD and my atty file for the IMR which has always ended in NO>>> You cant have that either! Despite the obvious pathology on the MRI, CT, EMG, and dental reports of the worst case of Xerostmia ever seen. I do not understand how the judge AWARDED ME for these body parts only to have the UR and the IMR process deny ALL TREATMENT since we settled the case, oh and the smal;l amount of cash I recieved was paid to the attorney and my in-laws for the $60,000 in dental loans over the past 10 years.
NO, sorry, the process is not working, I have been denied 100% of the 18..yes.. “eighteebn” UR/IMR reviews. I would like to know how to get help, as I cannot seem to find an attorney with any DESIRE to help the injured worker.
Thanks for the therapy ..as they denied that as well.
JB.
There is a problem with the new laws, and cannot comply especially with old injuries. There should be a clause for the old cases and medical that is promised. UR should not touch the old cases that have already been tried and tested with the AME, IME, QME and now after all these years, a new law comes into play and nothing is covered anymore, as was promised and also put into law.
During all of this new law making, sweeping everyone into this viscous cycle and one size fits all just cannot work. It creates victims and depression, and will most likely be responsible for the deaths of some.
Work Comp and the laws made by the Insurance companies who obviously paid the legislation with favors, have created a pure evil system, and all doctors who work for them have sold their souls and the oath they took, is long forgotten.
I’ve been told that WC suicides are very high. I certainly believe it. I’ve contemplated doing it myself because of meds being denied. CA Workers’ Comp is absolutely horrible, unjust, unfair and worthless except for the lawyers and “3rd party medical reviewers.”
I work in the work comp industry and I can tell you that this system most certainly is NOT working. For a 100% disabled claimant that has chronic pain, with lifetime medical, to be completely cut off of all medications, any physical therapy, any and all modalities of treatment and be forced to go through Medicare to get their medications is just ridiculous. These people just want to function and now CMS is going to be further in debt due to people with chronic pain having no other option than to go through Medicare. I would like to speak to the people that did this analysis and give them my full opinion on the matter. It’s not pretty.
Medicare won’t cover anything that has to do with a Workers’ Comp injury.
A few years ago I received a letter from Medicare claiming that my family doctor had charged them for a Workers’Comp injury. Several months later I received a bill from Medicare to reimburse them for the (erroneous) charge plus interest.
Fortunately my doctor straightened it out with them or I (not the doctor) would have had to pay Medicare over $4,000.00, which I don’t have being that I’m unable to work and only collecting a very small fixed income from Social Security.
Medicare won’t cover any Workers’ Comp injuries.
A few years ago I received a notification from Medicare that my personal doctor charged them for something that should have been billed to Workers’ Comp. Several months later I received a bill from Medicare for that charge.
Fortunately my doctor straightened it out with Medicare or I (not the doctor) would have had to repay Medicare over $4,000.00 plus interest added monthly.
CA Workers’ Comp is not working for the injured worker. It’s a total scam where meds, treatment, surgeries, etc are denied and there’s nothing the injured worker can do about it. Our government has betrayed the CA injured worker and it all benefits the employer and ins companies. I know of a Workers’ Comp executive who wouldn’t file a claim for their on-the-job injury because they know how corrupt and unfair the system is. Better they pay for their medical care on their own and not have this on their record. My meds have been denied and changed numerous times, despite the fact that my doctor of 15 yrs has given evidence of why the meds are needed for my serious spinal injury. May God do to these rotten people as they have done to us only much greater.