60 MINUTES LOOKS AT UR

In case you missed it, a recent segment on “60 Minutes” examined problems with utilization review of mental health treatment, albeit in a non-workers’ comp setting.

The program’s focus was on treatment denials by doctors doing utilization reviews for Anthem Health. A number of young adults who were at risk for suicide or violent behavior were pulled out of treatment by medical reviewers acting for Anthem.

One reviewer was making $25,000 per month doing reviews. He was well known for nixing treatment requests and gained the moniker “Dr. Denial”.

Many of the problems uncovered by “60 Minutes” correspondent Scott Pelley would also probably apply to UR in California workers’ comp.

Doctors who have a high rate of denial. Doctors who quickly issued a denial after waiting just a few minutes for a treating physician to call back A lack of contextual information that would allow the reviewer to understand the background of the treatment recommended and the patient’s situation.

Here is a link to the transcript of the show:

www.cbsnews.com/news/mental-illness-health-care-insurance-60-minutes/

Stay tuned.Before the New Year I’ll have a post on the Top 10 Developments in California workers’ comp in 2014.

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Julius Young