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Thread Title: Are expenses in calling for MPN doc due EE?
Created On Wednesday December 10, 2008 5:35 AM


stewshe@comcast.net
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Wednesday December 10, 2008 5:35 AM

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When I first considered this, my gut reaction was "no" and that while travel expenses might be reimbursable, phone calls, even long distance, were not.

There have always been some MPNs which seem to be more carefully composed than others, but I have recently had very bad experiences with a couple. I posted earlier about 14 psychiatrists in the Fresno area on one MPN. I spent 2 hours (total estimated over 2 - 3 days) calling and returning calls only to learn NONE of the docs listed would treat.

Some had been dead for 2 or more years.

Some had NEVER treated any W/C EE in the past 20+ years.

One did treat at his main office in L.A. or the Bay Area, but in traveling to Fresno for the past 10 - 15 years had only done QME work here.

Then I had a claim where the EE lived way out in the "boonies" and would have to travel a considerable distance to find a neurosurgeon.

After a month's searching he turned in his telephone bill with 56 long distance charges to EVERY neurosugeon in Northern California on the CA's MPN list. Only one would agree to see a w/c patient!

He requested that one, and of course the CA would have to authorize it. After a phone call from the CA, the doc refused to even set an initial exam! (12 year old case with several boxes of stuff!)

Bottom line? I think the long distance phone charges are reimbursable. The CA denied them and the DA of course agreed.

I think they are reimbursable. What should the EE have done? Written letters? At one letter/week, it would have taken over a year to find out none would treat!

Drive to each location? The CA would have had a kitten, or two, over the mileage and food/lodging expenses in driving....so that leaves the phone bills as a "reasonable" expense.

Does anyone disagree?

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Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

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TOBDNCNG@aol.com
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Wednesday December 10, 2008 8:35 AM

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I would ask the CA what they would rather have them do. Wait for years to find someone. I know from hearings I have attended that there are fewer and fewer neurosurgeons in WC in the state. I can't think of the organizations name, but they represent physicians. If you call them, if you can remember the name - they were at the new fee schedule meetings, and EAMS meetings, and talked about how few neurosurgeons there are in CA, all over CA. If I remember right, they said 17. I could be wrong though.

Hope that helps.

Glowing,

Marygrace~

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rider001
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Wednesday December 10, 2008 10:09 AM

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I think the correct thing to do is to contact the MPN and get these docs of the list. I would also contact the DWC audit unit every time this happens so they can access hefty fines against these carriers for not keeping an accessable MPN. Treat outside the MPN per Knight vs. Liberty Mutual. I would have to beleive that phone calls to access a MPN would have to be consider in the course and scope of employment. I cant see an resonable WCJ not agreeing.

9767.1
(21)
(C) If the listing described in either (A) or (B) does not provide a minimum of three physicians of each specialty, then the listing shall be expanded by adjacent counties or by 5-mile increments until the minimum number of physicians per specialty are met.

9767.14
(a) The Administrative Director may suspend or revoke approval of a MPN Plan if:
(1) Service under the MPN is not being provided according to the terms of the approved MPN plan.
(2) The MPN fails to meet the requirements of Labor Code section 4616 et seq. and this article.
(3) False or misleading information is knowingly or repeatedly submitted by the MPN or a participating provider or the MPN knowingly or repeatedly fails to report information required by this article.

(4) The MPN knowingly continues to use the services of a provider or medical reviewer whose license, registration, or certification has been suspended or revoked or who is otherwise ineligible to provide treatment to an injured worker under California law.




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TOBDNCNG@aol.com
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Wednesday December 10, 2008 9:21 PM

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The organization I was thinking of is CSIMS.

Hope that helps!

My neurosurgeon moved out of state because of this and the malpractice insurance rates. Lost a GREAT surgeon and miss him dearly.

Glowing,

Marygrace~

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