Two Questions:
1.
I have an Ortho PTP in the MPN and it is getting paid, refers patinet to RPT for Treatment
with a prescription. RPT is within MPN but does not get paid because he did not
request authorization. LC 4603.2 states "payment for medical treatment provided or
authorized by the treating physician." The PTP authorized the treatment which I interpret
as being approved. Is my thinking wrong?
2. Same question but the RPT is not within the MPN. I still believe the RPT should get paid.
Is my thinking off here too!
Thanks
4603.2. (a) Upon selecting a physician pursuant to Section 4600,
the employee or physician shall forthwith notify the employer of the
name and address of the physician. The physician shall submit a
report to the employer within five working days from the date of the
initial examination and shall submit periodic reports at intervals
that may be prescribed by rules and regulations adopted by the
administrative director.
(b) (1) Except as provided in subdivision (d) of Section 4603.4,
or under contracts authorized under Section 5307.11, payment for
medical treatment provided or authorized by the treating physician
selected by the employee or designated by the employer shall be made
at reasonable maximum amounts in the official medical fee schedule,
pursuant to Section 5307.1, in effect on the date of service.