tag:blogger.com,1999:blog-8489363879633129568.post6425016893304367307..comments2023-11-13T11:54:56.769-08:00Comments on DePaolo's World: Cost Containment Isn't ContainedAnonymoushttp://www.blogger.com/profile/02446191842560064784noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-8489363879633129568.post-37861244850429154512014-08-14T13:58:11.704-07:002014-08-14T13:58:11.704-07:00David - This is a daily fight for employers who ar...David - This is a daily fight for employers who are trying to help their injured workers so they don’t hire an attorney and increase the claims cost x 3. I suggest this process cost the employer between $50,000 and $100,000 each time an employee hires the attorney. Who we kidding UR is a profit center for the carriers and Sanhagen is the excuse that keeps on giving. Funny thing is I am on the Employers’ side having to fight for simple treatments even post surgery – what a joke!Anonymoushttps://www.blogger.com/profile/10055975784689523548noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-8377409852321420112014-07-01T08:17:58.914-07:002014-07-01T08:17:58.914-07:00Great post about UR. Some adjusters are sending al...Great post about UR. Some adjusters are sending all requests through UR. I agree this was not the intent of Sanhagen. A claims adjuster can approve OR send the request through UR. Many patients and treaters are not aware of how to appeal a UR denial. This is because it is complicated and you need a patients medical file in many cases. There is a UR appeal process that many do not use. <br /><br />I do believe for insurance companies this UR cost containment procedure is working. Many injured workers are basically getting denied all treatment requests and testing's. If they do not get the MRI then the complaints remain subjective. Many injured workers are not receiving proper medical treatment, they remain disabled due to this, their 104 weeks of TTD are used up, then they begin losing their home, cars possessions and in some cases their spouse. Complete loss of power is what injured workers go through in this system, and for many this is a loss of dignity.<br /><br />Then there is the other side of the coin where an injured worker gets a PTP that over tests over treats and does unnecessary surgeries that may disable the patient more. <br /><br />Both of the above examples are injured workers who are being victimized by the system.. I don't know which is worse.<br /><br />In regards to being late to a meeting. I was taught that is disrespectful. Treating each other with respect is important. <br /><br />anonwchttps://www.blogger.com/profile/12453763428300571418noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-47664327729527223232014-07-01T08:14:11.818-07:002014-07-01T08:14:11.818-07:00Keep on blowing your horn my friend.the injure wor...Keep on blowing your horn my friend.the injure workers and all the stake holders in the system I think, really need to hear what you have to say. Thanks. Anonymoushttps://www.blogger.com/profile/17682181549172380545noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-57343163074222275442014-07-01T07:45:14.456-07:002014-07-01T07:45:14.456-07:00Well said, David. Just as in driving instructions,...Well said, David. Just as in driving instructions, ‘the best way to get out of a skid is to turn into the direction of a skid’, the best way to resolve a workplace injury is to ‘lean into the injury’.<br /><br />If an employer will actively engage the primary care physician to determine the best treatment plan, then engage the claims adjuster to insure the treatment plan is authorized, as much as 60% of the total cost of work comp claims would be eliminated.<br /><br />Yes, there will be times when a claim is fraudulent or the injured worker has gotten an attorney. In both cases, the claims will be very expensive. But those will be the exception and, while individually expensive, will not have the positive impact that handling claims intelligently and responsibly will have.<br /><br />When the employer, employee, physician, and adjuster are all involved in the discussion and resolution of treatment plans, Utilization Review is never necessary. I’ve been involved in this for over a decade. I have never had a physician tell me anything but the truth about what the best treatment plan is, especially when the physician knows I will go to bat for him with the claims adjuster – both in getting authorization and getting the bill paid.<br /><br />This is ‘The Message’ David and I appreciate you bringing it to the masses. It may seem one-note, but keep it up. For everyone that wants to get the work comp system working better, it is simple – ‘Do the Right Thing, don’t do things right’.<br />billhttps://www.blogger.com/profile/16030231757371541081noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-70104198668976735052014-07-01T07:41:26.795-07:002014-07-01T07:41:26.795-07:00You hit the nail on the head, David, with your ass...You hit the nail on the head, David, with your assertion about the "deleterious effect" that the memo about being late to work had on most of us teachers. For crying out loud, I beat the principal in to work by an hour every morning. She needed to grow some courage and address the issue with the offending parties only...not the entire group! Signed, Mr. WeissAnonymoushttps://www.blogger.com/profile/17029396869512413993noreply@blogger.com