December 10, 2018

How to Combat Insurance Company Delay Tactics and Refusal to Authorize Medical Treatment

What can you do if your treating doctor wants to refer you to a specialist, or tries to order an MRI or CT scan, but the workers’ compensation insurance company refuses to authorize this needed treatment?
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Under Georgia workers’ compensation law, if you are receiving care from a “authorized treating physician” and that authorized physician refers you to a specialist, the referred doctor is supposed to be authorized automatically.

Similarly, if an authorized treating physician writes an order for an MRI, CT or other diagnostic test, that test should also be authorized.

What we are finding, however, is that when the referred doctor or the medical testing center calls the insurance company to verify that they will be paid, the insurance adjustor may say “no.” And of course, if a medical provider or testing center does not have a source of payment, they will not provide treatment to you. [Read more…]

The Nurse Case Manager – Who is She and Does She Belong on Your Case

[mc id=”175″ type=”audio”]Jodi discusses the role of the nurse case manager and when it makes sense to terminate her involvement[/mc]One of the lesser known players used by Georgia workers’ comp insurers is the nurse case manager. In the past, insurers could assign nurse case managers to every claim. Now, claimants and their lawyers can terminate the involvement of nurse case managers, except in the instance of catastrophic injury cases. Who is the nurse case manager and what does she do? In this short audio report, I explain how insurance companies sometimes use nurse case managers to try and influence treating doctors and I discuss a recent case in which I pulled the plug on a nurse case manager’s involvement.