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Thread Title: Can I collect an outstanding claim from 2004 from the WC Insurance Co?
Created On Saturday February 07, 2009 11:36 AM


MLBS
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Saturday February 07, 2009 11:36 AM

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Hello,

I have some old collections I was asked to work on for a chiropractor. They are from 2004 and 2005. The records show denials on most of the claims becuase of miscommunication between UR, adjuster, and PCP. I want to collect the money for him, but I want to know the best way to go about it. I resubmitted the bills with final request for reimbursement again and am waiting for a response. If I get a denial again, what should be my next BIG step because I am pissed at this point that they wont pay. I sdo not want to start an unprofessional screaming match with the adjuster. Also, any resources you all know of with the regard to chiropractor rights with California WC claim reimbursements? Any legal penalties and interest I can charge?

PLEASE HELP ME!

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STEVEPSCA@YAHOO.COM
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Saturday February 07, 2009 12:31 PM

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I can't answer you specific questions, but there is a thread in the 'legal' forum, discussing some of your issues with regard to the Chrio rights and reimbursement.
You are probably aware, due to your DOI's, that there is a cap on PT/OT and Chrio of 24 visits per claim/injury. Only the ER/IC can authorize additional visits...and there is no UR, or judicial review process to dispute this.

If the Chiro was acting in the capacity of a "PTP", there could be surrounding issues here... as an 'office call' is not necessarily a 'visit' for treatment purposes...


The thread is here...http://www.workcompforums.com/ca/pro/messageview.cfm?catid=5&threadid=5214



<< They are from 2004 and 2005. The records show denials on most of the claims becuase of miscommunication between UR, adjuster, and PCP. >>


This is really going back a ways... has the case in chief settled... were there liens filed ?
Was the denial appealed through LC4062 process by the IW/AA...? or exp herarings...? If the provider just dropped the issue due to 'miscommunication'... it would appear you have your work cut out for you...

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MLBS
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Saturday February 07, 2009 6:22 PM

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Thank you so much!

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