How do rules on emergency health care services differ from expedited reviews, concurrent reviews and other situations?
A. Emergency health care situations differ from other reviews, including expedited reviews, in that they are not required to be reviewed at all, but MAY be reviewed retrospectively. Emergency health care services are those provided when the injured worker has acute symptoms severe enough that they need immediate medical attention. For example, when a worker suffers a severe injury or illness on the job and must be immediately transported to the hospital for treatment. (8 CCR ยง9792.6(f)) Failure to obtain authorization in advance for emergency health care services cannot be the basis for refusing to cover the medical services provided to treat and stabilize an injured worker. However, emergency health care services may be subjected to a retrospective review. In that case, documentation for emergency health care services must be made available to the claims administrator upon request.
A. Emergency health care services are those provided when an injured worker has acute symptoms severe enough to require immediate medical attention. (8 CCR 9792.6(f)) Emergency treatment may be reviewed retrospectively. Documentation for emergency health care services must be made available to the claims administrator upon request. (CCR, Title 8 9792.9(d).) Failure to obtain authorization in advance cannot be the basis for denying payment for emergency treatment.
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