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

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!

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.

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Attorney answers 5

Posted

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 upon any legal advice.

Posted

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.

Asker

Posted

Mr. Micheals sends all my information to this doctor who is not part of the MPN? The nearest doctor Mr. Micheals from Von's risk management has said is Kosher is 150 miles from my house. When I signed off on the apportionment of the case, Vons and the Defense attorney promised I could see this particular doctor because he is the only one with-in 100 miles who takes WC Insurance. The rest of the psychiatrist have dropped WC and some have gone to work for the public sector because of dealing with WC's ability to shut them off in a heart-beat as a MPN. The same things happened with my doctor, two years ago Mr. Micheals after ten years of seeing my psychiatrist stopped paying him and denied my psyche claim. He is doing the same thing as before and Vons was suppose to cover my psyche care and now they acting strange. If they do not view my current psychiatrist as legitiment, why do they fill all medications and send him all the WC paperwork? Is this a HIPPA violation of my privacy by their refusal to pay and acknowledge him as my doctor? Why send my private notes from their former QME to a doctor not on their list?? Can I sue Mr. Micheals for a HIPPA violation for disclosing my secrets to a doctor (their QME) to a doctor Vons say's is not my doctor?

Asker

Posted

I settled my case with "life-time medical", and now they are denying my access to my psychiatrist. They want the psychiatrist to write the scripts for free, if Vons claims this doctor is not part of their MPN and refuse to pay him, can I sue Mr. Ed Micheals of Vons Risk Management for HIPPA violation rights? He sent confidential materials from their QME and other QMEs to this "Strange doctor we will not acknowledge as part of our MPN!" Mr. Micheals has stated on the phone that Medicare should cover my psyche care instead of my agreement with Vons. Can I call Medicare and tell them Mr. Micheals wants me to commit fraud?

Posted

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 various state laws that the information provided is a general overview of work comp law, which might not be applicable to you, based upon the laws of your state. We will not file anything on your behalf nor protect any statute of limitations which might arise and recommend that you IMMEDIATELY consult legal counsel for advice.

Asker

Posted

Can i sue Vons for a HIPPA Violation for sending medical information to a doctor not on their list? Is there a way to get outside of Workers Compensation law and hire a attorney to challenge Mr. Micheals leaking private information from multipule QMEs violation my privacy? When is a person allowed to step into the real law instead this Workers Compensation Limbo. I appreciate you helping all the UFCW members and your Solidarity to our members and workers, Safeway did a job on the poor members back in 2004 by trying to break the Union. Thank you again and God Bless you!

Posted

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.

Asker

Posted

I really like my lawyers, they both did a fantastic job even though Mr. Micheals used the UR and QME process for the most fractional cost. I thought Risk Management was to contain cost and use a company's funds the most effiecient way. My adjuster and his ability to balloon a minor cost into a full-blown capital expenditure is obscene! Is he trying to bankrupt Safeway by burning up their money? I wonder if he worked in Risk Management for Lehman Brothers, Bear Sterns or M.F.S. Global. How can California's system be fixed with wreck-less spending and outrageous cost-drivers if the adjuster does not care about their company? I worked with people like this at Safeway who were "buying their time", "putting in a appearance" by allowing gross waste, featherbedding, promoting under the "Peter Principle" and others who hated the company I loved!

Posted

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.

Asker

Posted

Who do we vote for, I thought Jerry Brown was going to help the legal community who help the injured workers. Where can I go to find people who are running for office who care about injured workers?

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