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Fed up with red tape and delayed
reimbursements by insurers, doctors surveyed
by the California Medical Association vow to
reduce or stop treating injured workers in the
wake of changes to the state workers'
compensation system, according to the Sacramento
Bee.
Although workers' comp overhaul has reduced
costs, it has created an environment
"that is hostile to physicians and often
harmful to the patients they serve,"
according to a report released by the medical
association.
CMA officials cited many physician
complaints about insurance carriers missing
legal deadlines for decisions on medical tests
and treatment, payments routinely delayed and
rulings made by nonmedical specialists.
The problems, the group said, could spark
more legal wrangling and cost insurers and
employers more money in the long term. The
group is urging the Schwarzenegger
administration to step up policing of
insurance companies and calling on lawmakers
to re-examine practices of 973 newly created
doctor networks.
"We have significant problems. We're
going to see premiums go back to where they
were. The administration is going to have to
do something about it," Jack Lewin,
association CEO, said during a news conference
in Sacramento.
Insurance industry officials disagreed with
survey findings. Carrie Nevans, acting
administrative director of the state Division
of Workers' Compensation, told the paper that
steps already are in place to address the
issues, including new financial penalties for
delaying insurance payments.
The division has commissioned the
University of California -Los Angeles to
evaluate the legislative changes and their
effects on treatment to injured workers. The
study should be completed this summer.
Nicole Mahrt, spokeswoman for the American
Insurance Association, told the paper that the
complaints arise from "growing pains
being felt by doctors used to the old system.
Doctors are frustrated by trying to follow the
new rules. The existing rules and regulations
are adequate to protect patients and
doctors."
Insurance officials said the association's
survey was too limited to draw solid
conclusions.
The CMA report was compiled from responses
by 250 physicians who handle workers'
compensation cases. Officials said the results
were not a scientific sampling, yet confirm
many issues raised by state physicians.
Among the findings:
*63 percent of doctors intend to cut back on
workers' compensation cases. Of that
percentage, a third plan to quit treating
injured workers.
*Only 1 percent reached an insurance
company claims reviewer on the first telephone
call; 68 percent of doctors said they needed
to make multiple attempts.
*40 percent said half their requests for
treatment were denied because of new medical
guidelines. But 43 percent of those surveyed
reported a quarter of their denials were
overturned when appealed.
Doctors were critical of the new networks,
claiming they focus more on getting physicians
to agree to fee discounts instead of following
a set of standard medical practices. They also
complained about out-of-state physicians
reviewing cases without having all the medical
records.
Because of increasing costs to treat
job-related injuries in the late 1990s and
early 2000s, lawmakers passed a series of laws
designed to lower medical treatment and
benefit costs by imposing new fee schedules,
uniform guidelines on treatment and benefit
payments.
Last year, a law was passed requiring
doctors to follow uniform medical guidelines
when evaluating a permanent disability. The
law also established a new HMO-style medical
provider network and a formula to calculate
permanent disability payouts to workers who
never fully recover from injuries, according
to the paper..
As a result, costs dropped 50 percent while
insurers' profits climbed, according to the
paper. At the same time, insurers have cut
premiums paid by employers by more than 30
percent on average since the first changes
were passed.
Critics have maintained the changes have
come at the expense of injured workers and
have made paperwork more cumbersome.
(article
taken from The Insurance Journal)
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