Who at the insurance carrier must review the variance request if the insurance carrier intends to deny the request?
If the insurance carrier denies the request for a variance on the basis that the treating medical provider did not meet the burden of proof that a variance is appropriate for the claimant and medically necessary, the variance can be reviewed by the insurance carrier’s designated point of contact. If the denial of the variance is for any other reason, the denial must be reviewed by the medical professional designated by the insurance carrier.
Related Questions
- Is a review of a variance request by the insurance carriers medical professional considered an independent medical examination (IME) or review of records? Also, what how long does the insurance carrier have to respond to the request if the review is performed by its medical professional?
- For denied variance requests, can an insurance carrier attach its peer review decision to the variance request and remain in compliance with the regulations?
- Can the insurance carrier request an IME or records review upon receipt of a variance request?
