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Proper Authorization for Medical Treatment

I have recently come across multiple situations where my client has been authorized for medical treatment, as in the form of an MRI or surgery or physical therapy, yet the medical providers are reporting to me and my office that they are not obtaining the proper authorization from the various insurance companies involved. I have had multiple clients and their doctor's report to me that they have been provided apparent authorization from the insurance company to proceed with the medical care but the insurance carrier is failing to provide the exact proper authorization, usually in writing, to the medical providers so the medical provider can document this and know that there medical expenses will be paid in full.

I have noticed that insurance companies and their representatives and their attorneys will often times verify that authorization has been provided but for some reason or another, the insurance company adjustor fails to directly forward the written authorization to the medical doctor's office so that the medical doctor can proceed with whatever procedure or treatment is being recommended. In these situations, I have to submit multiple communications to the insurance company and or their attorney so that the proper written authorization can be given to the medical doctor and or his staff. Often times I have to indicate that if they fail to submit the proper written authorization for the medical care requested, we will have to schedule a court hearing and we will request penalties against them for their failure to provide the proper authorization and medical treatment. In these types of situations, it is a matter of just simply being overly aggressive with the insurance company and or their attorney to make sure that any type of authorization that a person or a medical provider is seeking is properly provided to the doctor's office. Unfortunately, many doctors will not proceed with the medical treatment even though they have been given perhaps a verbal guarantee of authorization but they will not proceed until they have received written authorization. This can result in delay of that treatment or delay of the surgery proceeding forward or any other number of issues that may arise. It is important for you, as the injured worker, to make sure that authorization is properly given in writing to your doctor and or your doctor's staff, so that the medical care can be provided to you and there are no improper delays in receiving that medical care that can result in further harm or injury to you. If you have been involved in a work injury and are experiencing situations where medical treatment is being recommended, and you are not receiving the proper authorization, and your doctor's office is not proceeding forward as a result of this, it would be very important that you contact my office so that we can evaluate this for you and take you through the proper steps to make sure that this medical treatment is being properly authorized by your workers' compensation insurance company.

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