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does the claims adj have final say

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  • does the claims adj have final say

    One................
    Last edited by rear-ended; 02-20-2010, 09:37 PM.

  • #2
    Why would the boss butt in?
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      I think there is no way any of us may be able to comment on whether or not someone may disallow a claim for you.
      I find that the harder I work, the more luck I seem to have.
      Thomas Jefferson

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      • #4
        Not always...

        Not sure which state you are in but in CA, claims adjusters are only allowed to approve procedures. Any denial or modification must be made by a doctor in the same specialty. Usually this is done through UR (utilization review).

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        • #5
          I deal with a LOT of claims and the times I have ever seen an authorization revoked was when there was evidence after the initial authorization of fraud. There was one case where authorization was revoked after the presurgical tests came back and the employee in question was found to have a medical condition that made surgery far too risky, but in that case, the employee didn't wish to pursue surgery either. There would be little reason to randomly revoke an authorization for no reason.

          I'd stop worrying about all the unlikely maybes out there or you will make yourself nuts.
          I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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          • #6
            Pre-existing isn't fraud. Fraud is injuring yourself playing football in the yard with your kid and telling work that it was the accident that caused it. Or not being able to walk or lift even a purse at the doctor's office but able to go shopping immediately following and lift and carry large items from Wal Mart.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

            Comment

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