Safeway-Vons Company, Why do they reject everything from my doctors after I signed for medical treatment?

Asked over 1 year ago - El Monte, CA

Vons companies has been denying the "life-time" medical I was promised and this started after I signed with my attorney to accept their low-ball offer.

The denials must cost money, a random drug test "rejected, sent to UR and sent to my attorney, PTP, myself and Von's and Safeway. How much money does a random drug test cost and why would the adjuster at Vons reject it?

I was promised I could see my doctor and the adjuster sent him a letter rejecting him, this was why I signed the paperwork, my attorney said I would be able to see my doctor and now Vons is rejecting him and wont pay the bills for the past four visits. Vons pays for the medication prescribed by my doctor but won't pay his office bills and my adjuster at Vons plays a game of Chicken!

Additional information

I don't understand how he is able to be a good Stewart of Safeway's finances when he wastes so much money with unnecessary cost drivers like sending a $15 cost to the UR for review and building the original cost up to $1000 after going to court.

Attorney answers (5)

  1. George Ellis Corson IV

    Contributor Level 20

    4

    Lawyers agree

    Answered . This sounds like a question for your Attorney to answer/investigate/handle.

    We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY... more
  2. Irina Rubin

    Pro

    Contributor Level 10

    2

    Lawyers agree

    1

    Answered . Verify with your attorney that your doctor belongs to their MPN (medical provider network). However, even if he belongs to their MPN, your doctor's request will first to the UR (utilization review). So, even though you have a life time medical, all doctors' requests will go through the UR first.

    Yes, the denials and the UR cost them money. However, it also saves them money if doctors give up on their requests and, basically, go away. I don't know if you were seen by an AME (agreed medical examiner). If yes, your doctors' requests would have to be submitted to the AME instead of UR; at least until July 1, 2013.

    Good luck.

  3. Michael Ian Rott

    Pro

    Contributor Level 13

    2

    Lawyers agree

    1

    Answered . As a lawyer, who represents a good number of UFCW members throughout the state, I have come to understand that this is the path many Von's claims adjusters take. Therefore when we experience even the slightest delays, we file for a hearing...or get our client on the very next train to the PQME or AME. You will continue to experience similar delays and denials if you don't stand up to them. Remember, you have an award which entitles you to future medical care...you need to see that this award is enforced.

    Sincerely,

    Michael Ian Rott, Esq., Managing Partner
    HIDEN, ROTT & OERTLE, LLP
    2635 Camino del Rio South, Suite 306
    San Diego, California 92108
    Office: 619.296.5884, ext. 14
    Fax: 619.296.5171
    Cell: 619.252.2248
    Email: mrott@hrollp.com
    Web: www.hrollp.com
    San Diego - El Centro

    Please be advised that the advice provided does not create any attorney/client relationship; that due to the... more
  4. Peter Joon-Sung Hong

    Contributor Level 12

    2

    Lawyers agree

    1

    Answered . Your story and frustration is shared by injured workers throughout California. For better or worse, workers compensation has become increasingly contentious - and it sounds like your attorney fought hard for you to get this far. You should discuss this with your attorney.

  5. Richard Andrew Harting

    Pro

    Contributor Level 18

    1

    Lawyer agrees

    1

    Answered . while there may be some legitimate reasons for denial, this unfortunately has become the path of many wc insurers. You will need to fight them on this and request penalties and fees at every opportunity. A documented pattern can be reported to the department of insurance. And, remember your nightmare every time legislation comes around on the ballot - and spread the word.

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