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  1. #1
    Join Date
    Jun 2010
    Posts
    27

    Default Letter from Insurance Provider

    My workers compensation claim was made in the State of: Texas
    I just received a letter form I/C reads as follows:THE claimant has a chronic condition and there appears to be no clear rationale to transition the claimant toward invasive applications .
    Question1) is this Greek for a denial?
    Question2)What does this statement refer to? The provider may request a peer-to peer discussion if one did not occur before the decision was rendered, and we will facilitate peer discussion within one business day of your request.
    Last edited by clark k; 09-09-2010 at 06:59 PM. Reason: chk msg again for spelling

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Letter from Insurance provider Emg/Ncv#95860 Mri#72149

    I just received a letter form I/C reads as follows:THE claimant has a chronic condition and there appears to be no clear rationale to transition the claimant toward invasive applications .
    Question1) is this Greek for a denial?
    Apparently, as this notice is from the carrier/CA, you were evaluated by a Dr IME... the IME feels there is no reason to 'transition' or send you for surgery, "invasive" application, would be surgery, or possibly angiogram/angioplasty/stent or the like. What did your Dr recommend for treatment plan, that is obviously being denied at this point ?

    2)The provider may request a peer-to peer discussion if one did not occur before the decision was rendered,...your Dr may request a 'peer' review.. UR/Utilization Review under the dispute resolution process, or a "DD" Designated Doctor as provided in the TX WC Act. Ultimately, it's your Dr responsibility to provide the supporting rational for any treatment requested to "cure or relieve from the effects of your injury/illness".

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Letter from Insurance provider Emg/Ncv#95860 Mri#72149

    Quote: verbatim your first comment guessing /asking on my part the ''invasive'' refer is to the EMG/NCV ?
    The letter reads as follows: Request EMG/NCV to the bilateral lower extremities including #95860
    Explanation of Findings:The request for EMG/NCV of the bilateral extremities is not medically necessary in the management of this claimant's condition.
    Question: Can I take this as a standard ''NO'' answer to the request, with a possible ''YES'' to follow ?
    clark, there is nothing in the first post in this thread that mentions anything about a EMG/NCV... what it says is...I just received a letter form I/C reads as follows:THE claimant has a chronic condition and there appears to be no clear rationale to transition the claimant toward invasive applications ., Sorry, I doubt anyone reading this thread would be able to guess what the notice/letter is about...

    Question: Can I take this as a standard ''NO'' answer to the request, with a possible ''YES'' to follow ? No, you cannot ''assume'' anything. Talk to your treating physician.
    Question1) is this Greek for a denial?, No, it is what it is... the letter means exactly what it says. ...no clear rationale to transition the claimant toward invasive applications . "Invasive" applications generally means ''cut you open'', IE surgery.

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