Medical treatment guidelines are a delicate balance. Guidelines that are too restrictive may control costs in the short term, but limit necessary medical care to injured workers, who suffer unnecessarily, while outcomes fail to improve. Non-productive UR costs skyrocket when denials and friction clog the system, as good providers stop taking workers’ comp patients because they can’t get necessary medical care approved. Guidelines that are not restrictive enough, on the other hand, have little net effect. While ODG is unique in striving for and generally achieving this balance based on a thorough and ongoing review of the medical evidence, we still think it is important to allow for the possibility of exceptions. When and how those exceptions should be handled, together with explicit case study examples, providing the framework to ensure timely and appropriate medical care, should be clearly illustrated even for the unconventional injured worker.
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