QME Billing War Stories - Let's Hear Yours ! (California) (C

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QME Billing War Stories - Let's Hear Yours ! (California) (C

Postby appliedpsych on Wed Jul 08, 2009 4:37 pm

Here's just one of mine.

A self-insured city, San ___, had a psychiatrist QME who referred for neuropsychological testing regarding a head injury case and resultant problems that led to approved pscyhological treatment, and claims of injury to the psyche, as well as cognitive and memory problems. The psychiatrist got involved off a QME panel, and referred to a panel for a neuropsycholgical exam, given the head injury. I was the one picked off the panel.

The psychiatrist only billed one hour for reviewing the 400 pages of documents including neurological and medical reports, treatment notes, general medical records, etc. I guess he was a fast reader, as it took me 6 hours to review the same set of records, which were a mixture of well written typed reports, and hard to read handwritten treatment notes and lots of general medical notes and history. I note that the psychiatrist made no mention of what he saw in the records review.

When I billed appropriately for my time, the City of San ___ balked, saying that since the psychiatrist only took one hour to review the documents, that I could not charge more than one hour either, and that's all they would pay for.

Also, the psychiatrist had administered an MMPI - the old style, outdated version. When I felt it necessary to have the applicant take a different but similar test, the City of San ___ also replied that they did not have to pay for that time either, as since the psychiatrist had used one test to look at psych symptoms, that I should have just used those results as well, even though I explained it was an outdated test.

I went all the way before the WCAB Judge at a settlement conference I was asked to come to by the City of San ___ defense attorney.

The WCAB Judge backed the City of San ___, saying that "this applicant has filed way too many WC claims anyway".
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Re: QME Billing War Stories - Let's Hear Yours ! (California) (C

Postby Manila on Wed Jul 08, 2009 6:42 pm

Unbelievable as to what comes into play in the minds of people with the authority to make "rational decisions."
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