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Jacob Rosenberg Apr 27, 2023 a 7:15 am PDT
The problem is that the scheduling companies demand discounts from providers in order to receive patients. Everyone knows that kickbacks for receiving patients is bad. How is this different? We have seen how this works with physical therapy. Patients wind up with inferior treatment because the reimbursement is so low that physical therapists can only earn a living by limiting the time they actually spend with the patient. Patients wind up getting ice packs or heat or being put on a bicycle for 15 minutes.
We already have a problem with physicians not wanting to treat injured workers for a multitude of reasons. This will only exacerbate this problem.
Jacob Rosenberg MD
Diane Worley Apr 27, 2023 a 8:19 am PDT
With regard to AB 1213 I believe what Assemblymember Ortega said or intended to say is that 2022 data on IMR reveals that only 53 UR reversals would result in the extension of the 104 week TD cap under this bill as opposed to “issued after injured workers amassed 104 weeks of TD.” AB 1213 is narrowly tailored to address a specific problem.
Gary Nelson Apr 27, 2023 a 9:13 am PDT
I never really understood how the carriers are not fully protected by UR and IMR against paying for unnecessary (and necessary as well) treatment. They also have fee schedules on what they have to pay for treatments that are approved. Why the MPN system is also needed as a third bludgeon against accessible medical care escapes me.
Kimberley J Pryor Apr 29, 2023 a 7:51 pm PDT
Give them an inch and they will grab for the mile! It is not good enough that they can have an MPN with only industrial clinic doctors and UR to deny more treatment than is authorized, and bill review and the lien process that delay payment to doctors for years so that only a few non CMC or Kaiser doctors can survive, now they want to have secret MPN panels through One Call and Med Risk to cut access to care all the more. They are already trying this. One Call and Med Risk have secret lists of dentists, home care providers, etc that claims adjusters use with when a PTP refers, without even advising a the injured worker or their counsel they have a choice of treatment professional. This has happened on a two of my cases in the last few months. NO dentists on the accessible MPN, but the claims adjuster magically provides a separate "list" when we ask for non MPN treatment. They want TOTAL and ABSOLUTE control over treatment with no choice of treater for the injured. AB1278 will just makes it easier for them to circumvent MPN access standards, pay doctors and other professional less and there will be nothing we can do about it.
Think about it. How good can the medical care be if the doctors are paid less than Medi-Cal Rates?