Q: How often can a UR for medical neccesity be conducted on the same Dr. for the same treatment in Pa work comp?
I have been on comp for many years. Since 2008, my condition really hasn't changed. Only treatment is office visits every six months and meds to control pain. A UR of the Dr.'s treatment was done about one year ago and my treatment was deemed necessary. Comp requested another UR of the same Dr. for the exact same treatment about six months ago and the request was denied because the "treatment was already reviewed". In other words, Comp requested a review for consecutive visits of the same Dr. and the exact same treatmemt. How often can a UR be done on the same Dr. for the same treatment? There hasn't been any change in my condition and there hasn't been any new testing done. I know the Dr. doesn't enjoy this and neither do I. I have been reading everything I can find on the subject, but can't seem to find anything about how often they can do this.
A: There really isn't a hard and fast rule. There are cases that prohibit serial reviews of the same treatment if there isn't some form of change, but that change could include a change in treatment, symptoms, or even something new noted by an IME doctor.
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