IBR
Mar 31, 2022
Farmers Insurance: Winning "IBR Chicken”
California workers’ comp technically offers an appeals process for providers to dispute incorrect reimbursements. However, this appeals process actually encourages claims adm...
Mar 22, 2022
PPO: No Provider Recourse for Unnamed Discounts
In California workers’ comp, the appeals process for disputing improper Preferred Provider Organization (PPO) reductions has a serious flaw.Routinely, Explanations of ...
Mar 21, 2022
CA Workers' Comp: Appeals Rigged to Profit Payers
When a claims administrator incorrectly reimburses a California workers’ comp provider, the mandated process for the provider to dispute the error (or purposeful theft) is co...
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Feb 8, 2022
CA DWC Rigs IBR and Helps SCIF
A doctor treated a California injured worker. Subsequently, in an apparent attempt to avoid paying for the treatment, the State Compensation Insurance Fund deni...
Feb 4, 2022
MLPRR: Costco/Helmsman Play Med-Legal IBR Chicken
Call it “IBR Chicken: MLPRR Edition.” Third-party claims administrator (TPA) Helmsman, acting on behalf of self-insured employer Costco, refused to reimburse a physici...
Jan 13, 2022
Berkshire Hathaway: DWC Targeted Audit Needed ASAP
As Berkshire Hathaway HomeState Companies (BHHC) persists in its failure to compliantly process thousands of valid Second Review appeals, the California Divisio...
Jan 12, 2022
Berkshire Hathaway Ignores THOUSANDS of Second Review Appeals (& CA Law)
Berkshire Hathaway Homestate Companies (BHHC) continues to fail to compliantly process valid Second Review appeals submitted by California doctors to dispute erroneously deni...
Jan 11, 2022
IBR Chicken: SCIF Blinks Too Late
You win some, you lose some. That’s the lesson the State Compensation Insurance Fund (SCIF) must take from the latest round of California workers’ comp claims administ...
Jan 10, 2022
Intact Insurance Plays (Double) IBR Chicken
Welcome to another round of IBR Chicken! The rules are simple. To avoid reimbursing a doctor for authorized workers’ comp services, a California claims administrator m...
Dec 7, 2021
Berkshire Hathaway Refuses 892 Second Review Appeals
Berkshire Hathaway hath a way of defying California workers’ comp regulations, and refusing to pay doctors for authorized treatment provided to in...
Dec 6, 2021
JT2 Plays IBR Chicken (and Wins)
As we often point out, it can seem as if payers play a twisted game of IBR Chicken with doctors, reflexively denying bills and Second Review appeals only to change their mind...
Nov 17, 2021
Lien Chaos Returns: DWC Rules for Anthem (Part III)
California’s Division of Workers’ Compensation (DWC) has a duplicity problem. In the third chapter of our series on The Zenith and Anthem Blue Cross, we discover that ...