Dr. said 5 years. After 3 years went to yearly CT scans. I have 2 years left. This is a workers comp claim and they are now denying any further medical surveillance. Looking for a standard of care reference to challenge their decision.
Thanks

This is ridiculous. It is not like a screening is that expensive. Your dermatologist should be handling this. Typical insurance stall tactic. Your medical professional should set the frequency NOT the claims adjuster.

quote:

Originally posted by ZSMICHAEL:
This is ridiculous. It is not like a screening is that expensive. Your dermatologist should be handling this. Typical insurance stall tactic. Your medical professional should set the frequency NOT the claims adjuster.

Yes, it's ridiculous. But, workers comp cases are different animals. They have their own sets of rules, and each state is different. They don't care what treating docs recommend a lot of times. OP needs to challenge the ruling to the state, if he feels he has a strong case against them. Every state has some kind of body that oversees workers comp cases/issues. In TX, it's the TDI (Texas Department of Insurance).

Your doc should be able to provide the standard of care guide, or the American Cancer society, or whatever entity skin cancer is part of. Absolute bullshit. Every health issue has a standard of care for monitoring, and all the insurance company would have to do is look it up. They’re just putting you through the hoops. I frickin hate ‘em when they pull this shit.
Your employer is required to pay for this insurance, and they STILL don’t want to pony up (the ins co). I deal with patients who call every day trying to understand why ins denied, and often times it’s a loophole, or a “t“ that just needs to be crossed.

Q is right, workmen’s comp cases have their own rules.

Finding a standard of care won't help. These bean counters are simply trying to save money, because then they can include this on their resumes, when they are trying to advance their careers. They hide behind the organization. What I think I would do is to first get the names of the folks who are telling you that you are denied. Then I would go above them , to their supervisors and get their names. THEN contact both a lawyer and a politician that can contact the supervisors and their supervisors.

These bean counters depend on their anonymity. They want to stay in the shadows. About the only leverage that the common person has is to make your problem public.

I'm a bitter bastard ( as you can see) ....personally I would also make up signs and place them on my vehicles with a short description of your complaint and include the names of the people making those decisions. Phone numbers ( business phone only) would be even better. Then take a photo of the signs and send to the workman's comp folks. I would put an ad in Craigslist ( don't include your real contact info) as if you were selling your car. I'd make sure that you could read the signs in the ad. " Reason for selling , is to pay for cancer screening denied by workman's comp". Be sure to send the link to workman's comp !!

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Q is right, workmen’s comp cases have their own rules.

^^^^^^^^
That is correct. Every state has a different fee schedule as well. We are not exactly talking big bucks here and I have found a call to the Nurse Case Manager often solves these problems, particularly if you have been reasonable in the past. Good luck!