California Medical Review and Dispute Blogging Live WCRI Conference
California Medical review and dispute is a white hot topic amongst risk managers presently. One of the hot sub-topics now is the amount of money charged for UR (Utilization Review) in California.
In our claims loss run analyses, we find that California ALAE Allocated Expenses to handle a claim can actually cost more than the benefits provided to the injured employee. No other state comes close to this amount.
One recent estimate showed that the cost for UR was more than the medical charges themselves. The UR charges have grown steadily over the past ten years. The employers have to pay the final bill for the UR charges either by paying an increased premium due to the rates and a higher XMod or budgeted funds for the self insureds.
As this one is in the conference book, and there were so many great charts which covered so much great info, I will cover this one soon. I cannot give this section justice without reviewing the charts more closely. I am trying to juggle doing interviews with the presenters and doing live blogging.
Some of the more interesting statistics-
- 1% of doctors accounted for 46% of IMR (Independent Medical Reviews)
- 50% of pharmacy benefits go to IMR – no other medical service even close
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