{"id":331,"date":"2014-01-25T11:41:04","date_gmt":"2014-01-25T20:41:04","guid":{"rendered":"http:\/\/www.keenanpowell.com\/blog\/?p=331"},"modified":"2014-01-25T11:41:04","modified_gmt":"2014-01-25T20:41:04","slug":"can-the-insurance-company-refuse-to-pre-authorize-surgery","status":"publish","type":"post","link":"https:\/\/www.keenanpowell.com\/blog\/2014\/01\/25\/can-the-insurance-company-refuse-to-pre-authorize-surgery\/","title":{"rendered":"Can the insurance company refuse to pre-authorize surgery?"},"content":{"rendered":"

\"bigstock-Silhouette-1113353\"<\/a><\/p>\n

There\u2019s been a recommendation for surgery.\u00a0 The surgeon\u2019s office calls the insurance company requesting it to pre-authorize the surgery so the surgeon knows he\u2019s going to get paid.\u00a0 Then the insurance company either flatly refuses to pre-authorize the surgery or doesn\u2019t return the surgeon\u2019s call.<\/p>\n

So the employee can\u2019t get the surgery and can\u2019t go back to work because the doctor won\u2019t release him to full duty.\u00a0 Meanwhile, his employer has replaced him.<\/p>\n

If the employee can get an adjuster on the phone, the adjuster tells him that the insurance company does not have a duty to pre-authorize medical treatment.\u00a0 The adjuster suggests that the surgeon go ahead and perform the surgery and the insurance company might pay the bill afterwards knowing, of course, the surgeon won\u2019t do that.\u00a0 Or, the adjuster will suggest, the employee can pay for the surgery himself and ask for reimbursement.\u00a0 Like, who has the money for that?<\/p>\n

This situation is so common that over twenty years ago, the Supreme Court for the State of Alaska ruled an injured worker who has been receiving medical treatment should have the right to prospective determination of compensability.\u00a0 Summers v Korobkin Construction<\/i>, 814 P 2d 1369 (Alaska, 1991).<\/p>\n

That means filing a claim.<\/p>\n

It also means you can get an attorney.\u00a0 The second thing the insurance company is trying to do, other than denying medical benefits, is preventing the injured employee from finding a lawyer to represent him.\u00a0 When you call for an attorney, most lawyers will ask \u201cHave you been controverted?\u201d\u00a0 That means have you received a formal Notice of Controversion (a document) from the insurance company.\u00a0 If the answer is no, many attorneys aren\u2019t interested in the case because, as a rule, the attorney cannot bet paid if the claim hasn\u2019t been controverted.<\/p>\n

But there are formal and informal controversions.\u00a0 If the insurance company has resisted paying benefits, then its action constitutes a \u201ccontroversion in fact\u201d and justifies an award of fees.<\/p>\n

If you hit a wall when you tell the person answering the attorney\u2019s phone that the claim has not been controverted, call another attorney. Keenan Powell has more than 30 years experience fighting for the rights of injured Alaskans.<\/p>\n

At the Law Office of Keenan Powell, you can get a free consultation by call 258-7663.<\/p>\n","protected":false},"excerpt":{"rendered":"

There\u2019s been a recommendation for surgery.\u00a0 The surgeon\u2019s office calls the insurance company requesting it to pre-authorize the surgery so the surgeon knows he\u2019s going to get paid.\u00a0 Then the insurance company either flatly refuses to pre-authorize the surgery or doesn\u2019t return the surgeon\u2019s call. So the employee can\u2019t get the surgery and can\u2019t go ...continue reading \"Can the insurance company refuse to pre-authorize surgery?\"<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[3],"tags":[],"class_list":{"0":"post-331","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-workers-compensation","7":"h-entry","8":"hentry","9":"h-as-article"},"jetpack_publicize_connections":[],"yoast_head":"\nCan the insurance company refuse to pre-authorize surgery? - Keenan Powell, Attorney at Law<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.keenanpowell.com\/blog\/2014\/01\/25\/can-the-insurance-company-refuse-to-pre-authorize-surgery\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Can the insurance company refuse to pre-authorize surgery? - Keenan Powell, Attorney at Law\" \/>\n<meta property=\"og:description\" content=\"There\u2019s been a recommendation for surgery.\u00a0 The surgeon\u2019s office calls the insurance company requesting it to pre-authorize the surgery so the surgeon knows he\u2019s going to get paid.\u00a0 Then the insurance company either flatly refuses to pre-authorize the surgery or doesn\u2019t return the surgeon\u2019s call. 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