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Senate Hearing Highlights wide Rift in Reforms Assessment

  • State: California
  • Topic: Top
  • - Popular with: Legal
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SACRAMENTO, Calif. – A three-hour Senate hearing aimed at evaluating the successes and remaini…

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Do not post libelous remarks. You are solely responsible for the postings you input. By posting here you agree to hold harmless and indemnify WorkCompCentral for any damages and actions your post may cause.
Rhonda Wofford Nov 3, 2016 a 2:58 pm PDT

It was a one-sided bill that was created in secret, had virtual no public hearings due to a procedural loophole; and when it was revealed, it met with wide criticism, that was quashed as it was passed with more dirty backroom deals. It is very simple, a pile of dog poop is still a pile of dog poop; even if, you pour chocolate syrup over it. I still am not going to eat it and tell you that it tastes good.

The real problem will be on the providers end. The late implementation in the RBRVS; then followed by, the systematic downcoding of office visits and the elimination of records review has resulted in significantly less money in the providers' pockets. That is reflected in the 8.3% decrease in medical costs; instead of, the 9.7% increase that was projected. Carriers' reimbursement has become significantly more questionable since they don't have to fear a liens being filed due to the twin IMR/IBR exclusions for doing so. And, the practice of revisiting agreed-upon Future Medical Award treatment with UR/IMR is a highly questionable practice that threatens IW's vested rights under contract. All told, a big win for employers and carriers by cheating the system, a big loss to IW's and providers due to their political apathy and reactionary posture.

Barbara Ramiller Nov 3, 2016 a 2:58 pm PDT

do you realize that the insurance companies were not even involved with these discussions it was between the employees and the employers. So saying it was one sided is just ignorant.

Anonymous Nov 3, 2016 a 2:58 pm PDT

Hmmm, that dog poop tastes mighty tasty. Could I have an extra helping? Hold the nuts!

Anonymous Nov 21, 2016 a 6:49 pm PST

Absolute your statements are absolutely true.

Dr. Robert Weinmann Nov 3, 2016 a 2:58 pm PDT

"As long as wrongful decisions by Utilization Review (UR) physicians are allowed to be upheld by anonymous Independent Medical Review (IMR) surrogates, injured workers will continue to be deprived of indicated and necessary medical and surgical attention ... in one case our office got a denial while the supporting information we were sending was still in our fax machine" -- quoted from workcompcentral reply, 02/11/15. Workcompcentral re "Senate Hearing," 03/26/15, points out that "about 91% of the UR decisions that are appealed through IMR are upheld." That says it all. This level of flat-footed UR support cries out for investigation by the state medical board or for a RICO investigation. Robert L. Weinmann, MD, Editor, www.politicsofhealthcare.com

Dr. Robert Weinmann Nov 3, 2016 a 2:58 pm PDT

"UTILIZATION REVIEW: HYPOCRISY IN VELVET GLOVES," originally published in www.politicsofhealthcare.com, reprinted in Workcompcentral, 3/26/15, revealed how a Utilization Review doctor told a treating physician's office about denied authorization at 10 PM when the office was closed. When the treating doctor eventually found out and complained a second Utilization Review doctor was appointed. The second utilization review doctor also denied authorization and left a message so saying at the treating doctor's office at 4 AM (yes, that's 0400 hours, in the wee hours of the morning). This behavior is accepted by the insurance companies. It is further reason why SB 863 needs to be revamped or repealed. -- robert L. weinmann, MD, Editor, www.politicsofhealthcare.com

Anonymous Nov 21, 2016 a 6:49 pm PST

I really enjoy reading your replies Dr Weinmann. Thank you for advocating for California injured workers. You are appreciated.

Anonymous Nov 21, 2016 a 6:49 pm PST

http://forums.workcompcentral.com/viewtopic.php?f=46&t=2547&st=0&sk=t&sd=a&sid=3d72a3eed2075c6d9f3fa021409ec12e This peer to peer UR issue was also written about on Workcompcentral forum. "Not I said the fly" "Not me said the flea"....

John Kamin Nov 3, 2016 a 2:58 pm PDT

Here's a suggestion: give labor most of what they want, in exchange for a two week-SOL on CT claims from the date of termination. Doing this would weed out many of the fraudulent claims currently clogging the system.

John A. Don esq. Nov 3, 2016 a 2:58 pm PDT

Quick fix - No more UR for MPN doctors.

Problem solved!

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