My Doctor Has Requested Certain Tests Or Procedures And I Am Waiting For Authorization. What Do I Do?
If your doctor is requesting authorization for treatment for your knee, shoulder, neck, or back, the doctor must refer to the new Medical Treatment Guidelines that became effective on 12/1/10 to determine whether the treatment is within the guidelines and if the procedure or medical care is considered authorized without prior approval. If the procedure or treatment is beyond the guidelines, the doctor must complete the appropriate forms to request authorization.
If your doctor is requesting authorization for medical attention for sites other than your knee, shoulder, neck, and back that costs less than $1,000.00, there is no need to obtain authorization from the carrier. If the medical requirement or test costs more than $1,000.00, they must submit the appropriate request form. The carrier has thirty days to answer the doctor's request for authorization and either deny the request or approve it.
All of the authorization request forms are detailed and require accurate and thorough completion in order to be considered by the Workers Comp Board. They must be sent directly to the carrier, the Workers' Comp Board, and the Claimant's attorney. If the carrier has not responded timely, there are procedures to have the Board authorize the treatment. If the carrier denies medical care, litigation may be required.
I just wanted to let you know how happy I was with the job that Maggie Langdale did in getting me approved for SSDI and maybe more importantly, not having to have a review for another 5-7 years! Now I can concentrate more on my health, especially with the added benefit of Medicare next December.
Maggie went out of her way explaining every step of the process and answering all my questions on the phone or immediately after I emailed her. We reviewed all my answers to the lengthy paperwork and made several important changes. I would definitely advise anyone to use Maggie and your law firm!