A 19.4% increase in costs for prescription drugs and durable medical equipment in 2012 drove an overall 2.3% increase in average medical benefit payments per indemnity claims, the California Workers' Compensation Institute reports.
Carriers paid an average of $16,375 in medical benefits per indemnity claim at the 24-month period for accidents occurring in 2012, compared to $16,003 on claims for injuries occurring in 2011, CWCI said in a research report published...
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“We have limited PT, Chiro, surgery is not being authorized. We as doctors, feel the need to treat our patients. If we prescribe NSAIDs or give patients TNS units, is that really unreasonable? Is this all a backlash to the few abusers out there, who we have been reading about? The biggest medical expenses are UR and IMR. They were not mentioned in this report. If you want to analyze costs, put them all in the mix.”
By: Anonymous, 11/24/2014 04:11:59 am
“UR and IMR are both being overly used. I had spinal surgery and received 12 post surgery aqua therapy appointments. It was helping. My PTP requested an additional 12. This was two months ago. It has gone through UR and denied due to claims adjuster did not send relevant records, and no records stating I am recovering from a spinal surgery, no PT records etc. I appealed the UR and it was denied again due to the records I sent the UR company, only some were forwarded to the UR reviewer. I am now awaiting IMR decision. How much did two UR reviews and an IMR cost as apposed to just providing me with the post spinal surgery PT? The ONLY reason it was denied in the first place is due to claims adjuster not providing relevant records. This system is unbelievable! The middle men are making money off of reviewing medical necessity and my adjuster would rather pay for reviews than just authorize the treatment. Since I have been successfully appealing all UR denials on my own, now the records and appeal letters I send directly to the UR company are being omitted by the UR company and not forwarded to the UR reviewer. I guess they do this once they see an IW is successfully appealing their denials. The sad thing is, after waiting for two months, my condition has already regressed and I wonder if additional PT would help at this point. It would have been nice to get consistent PT after a spinal surgery, as it was helping me. This is my 3rd spinal surgery. I do my best at home exercises, but not the same as aqua therapy and I cannot tolerate land PT. I have spent my own money trying other types of therapy, but aqua therapy is the only one I can tolerate. I would do just about anything to get to a place physically in which I could return to work.”
By: Anonymous, 11/24/2014 10:11:55 pm
“Forgot to write, thank you Greg Jones. Good reporting as usual. I love reading your well written reports.”
By: Anonymous, 11/24/2014 10:11:49 pm