No Written PTP Authorization? No MPN For You!
Happy Friday, dear readers!
Your humble blogger has received the countless e-mails, letters, carrier pigeons, and threats regarding the glaring deficit of MPN-related blog posts. I have heard you, dear readers, and I will comply!
But, as your humble blogger is equally ready to hear your demands as he is to disappoint you, don’t expect a happy ending to today’s fairy tale.
The case is that of Pomona Unified School District v. WCAB (Bryant), in which the Court of Appeal recently denied review of the WCAB’s denial of defendant’s petition for reconsideration.
Basically, applicant-teacher had resolved his claims by way of stipulated award and decided to use his right to medical treatment to undergo knee surgery. He requested a physician from defendant’s MPN, but, even though the adjuster authorized the treatment by phone, two months later, no written authorization had issued.
Following an expedited hearing, the WCJ held that applicant was entitled to treat outside of defendant’s MPN because defendant had “failed to provide medical treatment.”
On review, the WCAB denied reconsideration, and likewise held that applicant is entitled to treat outside of the MPN.
Now, in reviewing this opinion, your humble blogger is a bit puzzled: if there is a defect in the MPN, either in its coverage or in the prompt authorization of treatment, shouldn’t the defense be entitled to cure the defect? Sure, perhaps applicant can self procure treatment from the point that care should have been authorized to the point that it eventually would be authorized… but should defendant’s MPN be invalidated going forward?
One of the interesting thoughts from this scenario is the terms of authorization for an MPN physician. Membership in an MPN is a negotiated benefit – doctors and insurers can bargain for the terms of service, including the billing rates and the methods of reporting. Perhaps future exploration of MPN versatility should include accepting phone authorization, rather than requiring a written one?
In any case, dear readers, let’s just use this case to remind ourselves of the importance of getting our authorization letters out promptly!