Workman's comp question

Has anyone here dealt with workman's comp paying for the ADR???

[Mariaa]

I have been authorized twice by WC to pay for 2level ADR surgery however, have yet to do it since I wanted to wait for FDA approval of pro disc in case I needed 3 levels.

I see you're in CA so it will have to go thru Utilization Review and my surgery was "non certified" or not approved by UR so this was over-ridden by the WC insurance carrier and they agreed to pay for it. Depends on your carrier as to what they will do if UR denies it...

what is utilization review??

[Mariaa]

Utilization Review is a system to of independent medical review of medical cases based on industry standard protocols to provide supposedly the most optimal care possible for the individual (patient) and managing cost containment for the insurer.

My case was denied by UR, however as I said, the WC insurance carrier is willing to pay for it (up until now at least)...

[Dano]

Hi Zack, and Marria.
Hope your day is going well. Zack as we talked on the phone and how eloquently Marria, just explained, UR is new to the CA system. The guidelines they use are from "ACOM" I don�t know what it stands for but, according to my Drs. the ACOM guidelines are just that "guidelines"
So it really depends on how experienced your whole team is at maneuvering through this new bureaucratic mess. Good UR people can help improve care. But the system is brand new. You get more with sugar than salt, so dont piss off the UR guys if you can help it. If you need any more help let us know!
Take care, Dano