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Workman comp fee schedule for service

Stockton, CA |

I have a low back injury and before my injury I use to be very active and so the qme advised that I have a 3 month exerciser program to prevent flair ups and further injury. I was approved for a pain management program by the UR Board and the program is like 35k. The adjuster said I can go t the program but only willing to pay the fee schedule but all the pain management program are the same price or more. There programs are most for workmen comp and have great success rates so there must be a law that gives exception to the fee schedule ..right"?:

Attorney Answers 3

Posted

Since UR approved the treatment, you should not have to pay for anything. If there is a billing dispute that is between the medical provider and the defendant. Go get your treatment and get well soon.

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Asker

Posted

Well, program wont do the program unless the insurance company agrees to the prices and the adjuster is saying they agree to the service but they are going to have to lower their fees. they are not going to do that and there are many programs out there like that. So, I can't have the program unless they agree to pay for the approved services that cost 35k. The UR Board has it set up that I can only go two weeks and then get approved for the next two weeks and so on until the program is over. The program is roughly 10 weeks

Daniel W Epperly

Daniel W Epperly

Posted

You probably need to get an attorney. It sounds like you need to file for an Expedited Hearing and you may be able to do that yourself but better to have an attorney on your side. I have met T. Mae Yoshida and Gary Nelson who both practice WC out of the Stockton Area. Good luck to you.

Asker

Posted

Thank You Sir

Posted

The fee schedule rules. Unless pain program accepts that, you have to find one that will.

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Posted

Mr. Epperly is correct that since UR approved, you won't have to pay anything for pain management.

Ms. Harris is correct that now you need to find a pain mgmnt program willing to accept fee schedule.

Mr. Epperly is correct that you also need to find a good WC attorney. Yoshida & Nelson are both very good. David Rockwell is one of the best in California. Find all of them here at www.avvo.com or at www.caaa.org.

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Asker

Posted

Well, that was the reason for getting it authorized by the UR Board because all Well, perhaps I said it wrong,. The name of the program is Functional Restoration Program and there are only a few and they are all very expensive and can only be had after many failed attempts have been made. There are no Fee schedule Representational Programs but they are approved only after all else has failed. see sacramento functional restoration program

Asker

Posted

Oh, and The UR Board rarely approves them because they are so expensive and most people are denied but because of my history it was immediately approved by the UR Board

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