Medrisk

6/02/17Dear [redacted] We have received your written notice of a complaint dated 5/23/2017.The complaint was filed by an injured worker who is claiming that MedRisk was "denying medical care".It is important to understand that MedRisk is a managed care organization, Our customers are insurance companies and third party claims administrators (TPAs) who cover workers compensation claims.As such, MedRisk does not authorize OR deny medical careOnly the insurance company of the TPA can make that decision - and only after they carefully examine all the details of a patient's case.MedRisk's role is to help the patient find a provider after authorization, help him schedule the appointment and then facilitate future communications between the insurance company or TPA claims adjuster and the treating provider.We do know that the world of insurance and healthcare can sometimes be confusing for a patient- and we thoroughly train our customer service team on how to help educate patients about MedRisk's role during the course of careIf confusion persists, we always encourage the patient to reach out to his or her claims adjuster for more information.After carefully reviewing our documentation, we do see that the patient called on 5/10; he was very concernedEvery attempt was made to clarify MedRisk's role in the process and the patient was encouraged to talk to his claims adjuster for additional clarification, verification and to alleviate any concerns or anxiety.This was especially important to all of us here at MedRisk because our records showed that at the time the claims adjuster was actually authorizing continued care.We hope that the patient finally connected with his claims adjuster and that he feels better soon.If you have any questions about this case or require any additional detail, please do not hesitate to contactSincerely, Ronny BExecutive Vice President

medrisk is the tpa as they stated they are the ones sending the denial not the insurance company I have still requested what records they have with no response

medrisk is the tpa as they stated they are the ones sending the denial not the insurance company.  I have still requested what records they have with no response

6/02/17Dear [redacted] We have received your written notice of a complaint dated 5/23/2017.The complaint was filed by an injured worker who is claiming that MedRisk was "denying medical care".It is important to understand that MedRisk is a managed care organization, Our customers are insurance...

companies and third party claims administrators (TPAs) who cover workers compensation claims.As such, MedRisk does not authorize OR deny medical care. Only the insurance company of the TPA can make that decision - and only after they carefully examine all the details of a patient's case.MedRisk's role is to help the patient find a provider after authorization, help him schedule the appointment and then facilitate future communications between the insurance company or TPA claims adjuster and the treating provider.We do know that the world of insurance and healthcare can sometimes be confusing for a patient- and we thoroughly train our customer service team on how to help educate patients about MedRisk's role during the course of care. If confusion persists, we always encourage the patient to reach out to his or her claims adjuster for more information.After carefully reviewing our documentation, we do see that the patient called on 5/10; he was very concerned. Every attempt was made to clarify MedRisk's role in the process and the patient was encouraged to talk to his claims adjuster for additional clarification, verification and to alleviate any concerns or anxiety.This was especially important to all of us here at MedRisk because our records showed that at the time the claims adjuster was actually authorizing continued care.We hope that the patient finally connected with his claims adjuster and that he feels better soon.If you have any questions about this case or require any additional detail, please do not hesitate to contactSincerely, Ronny B. Executive Vice President