Q: One time consultation rendered diagnostics. IA denied sending thru UR. Does Sandhagen apply?
I don't understand how to respond to a lawyer's response to my initial question on this website .. If that is even possible. So I am adding more details in this question. The DA allowed a 1x consult to a neurologist. She put this in writing. Three lawyers down (and three years later )and it still hadn't happened. Now pro per. We went to court. Finally it happened. Nothing in the initial letter to this "secondary treater" (as was referred to by DA in said letter) restricted his ordering diagnostics. Second and third opinion doctors , consulting doctors, all are allowed to order diagnostics. Nothing in court stips (from msc that ordered consult) restricted neuro from ordering diagnostics. Regardless of what ptp does or doesn't do, I believe I have a sandhagen defense/argument because the properly submitted RFA wasn't sent thru Ur. It was denied by IA with reason being "it was 1x consult". Notification to applicant was never served but Dr was notified in 5 days. Thoughts?
A: My answer urges you consult a lawyer. Not here in bits and pieces but over the phone at least. A carrier can deny a body part but all any manner of consultations. For deniedbody parts a PQME is needed unless the denial is legal rather than medical.
A: A 'consult' means ONLY that you are face-to-face with the physician. it DOES NOT include anything else. Your question presumes that if consulting physician suggests a test, the approval of the consultation magically approves any testing suggested. IT DOES NOT. WRITE and visit and petition and fax and phone your Assemblywoman, your State Senator and your Governor that the Labor Code is hurting injured workers and is leaving them with no treatment for years, making temporary injuries permanent disability. Actively campaign against your State Senator and Assemblyman and let them know you will vote for a Ham Sandwich instead of them because of the Labor Code hurting injured workers. Millions are hurt and denied tests and they won't vote out the bastards who deny their diagnostic studies. It's been happening for 6 years. People have friends and family seriously hurt by the Labor Code and they keep voting for the same people who put the law into place hurting them. The insurance company is doing exactly what the law says: get a suggestion for a test, review it, deny it. It's all legal. and you voted for the people who voted for that.
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