Utilization review, medical provider networks and workers compensation news UR & MPN

 

These are the names of some of the Utilization Review (UR) organizations who are tasked with evaluating the medical needs of California’s injured workers:

Their names say it all. They get paid to deny claims. And they do.

But they don’t just hurt injured workers. They drive up costs for employers who pay the bills.

On average, claims that aren’t denied cost $16,833 for medical care. But out of every 100 denied claims, 82 of the denials are overturned at an average cost of $27,419.

Do the math. 100 claims that aren’t denied cost $1.68 million. 82 denied claims end up costing $2.25 million. Who pays this increased cost? Your employer does when the insurance bill shows up and you do in aggravation waiting for medical care.

These UR companies raise the cost of workers’ comp in California while making California the slowest state in the nation to provide the medical care the company’s own chosen doctors prescribe.

The Brown Administration set this system up. The Newsom Administration might want to review Utilization Review.