Work mans comp insurance co denied emergency room bill....?

Question

I been injured sence 1/19/07.At first I did not get an attorny bcouse I was told id be taken care of by the insurance co.Well 4 month into it I was cut off with no explenation or fearther care basicly found out when I went to refill my perscription the pharmsist told me i didt have coverage.I got the attorny and got medical care again.Their has been a few issues I feel arnt fair or just.4 starters the insurance co is sending to a Dr 2 hours away!that means a 4 hour car trip a min of every 2 weeks.My injury is in my lower back so this is a painfull trip.when asked why I couldnt see a dr in the local area I was told the insurance co just dosent use those dr and they didnt feel comphertable useing dr they wernt fermairler with. Iv had 3 crysis sistuations where I was afflected by accut extream pain that required an emergcy room visit I recived a bill today saying it was an unortherised visit and they were not going to pay the bill?Im wondering can they do they do that?

How would one go about getting autheration in the middle of the night or on weekends?Also one visit did happen during work hors and the r office couldt or wouldnt do any thing for me at that time.I feel the 2 houre distance is hampering my care at this point do I have grounds or a right to request a Dr that is closer to home?The last question I have is at every turn the woman who works for the insurance co trys to denie medical services for instance I could not tollerate a procudure with out sedation and the dr ordered it with sedation and she tryed to denie it.She even went as far as to tell my attorny I was hesterical and out of contoll in the dr office!That was so far from the truth.Iv never met this case worker but it feels like it personail for her.Iv talked to her one time on the phone before I got my attorny and she was just plain rude and mean.Can I request anouther case worker from the insurance co?

Note:I will be asking my att but these questions happen to be bothering me on a sunday night just want to know outhers suggestions and thoughts

I do work nights

Answer 1

Workers comp benefits are NEVER pre-authorized. You have the medical care, and then the insurance company accepts the claim and pays it, or denies the claim and doesn't pay it. From what you're describing, your claim has been denied already, and you've hired an attorney to fight it - so they aren't going to cover ANYTHING until/unless a judge makes them accept this claim.

Unless you're WORKING evenings or weekends, when you get the first injury, the emergency room is NOT going to be the appropriate place for care - your doctor is. It's going to be presumed, that if all of a sudden you have to go to the emergency room, then something ELSE caused the new injury.

Answer 2

You have an attorney - ask him. That's what you are paying him for.