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Doctors Who Do Utilization Review Should Be Licensed In California
By Robert L. Weinmann, MD
In early April, 2009, while working in the Capitol for AB 933 by Paul Fong, I encountered management lobbyists blithely misinforming legislators about AB 933. The management lobbyists were telling legislators that the bill would require utilization review doctors to live in California. This assertion is false.
AB 933 says "this bill would require the physicians to be licensed by California state law."
Because of a quirk in how labor law was written, some insurance companies have been using non-California licensed doctors for utilization review. These doctors have not had to do the required 12-hour course in pain management that is required for doctors with California licenses. The non-California licensed doctors are also not responsible for 26 pages of California-specific regulations governing utilization review.
Some insurance companies prefer non-California licensed doctors because these doctors cannot be sanctioned for mistakes by the Medical Board of California since they're not licensed in California. They also cannot be sanctioned by their own state boards since those boards don't have jurisdiction in California. What the non-California licensed doctor enjoys is a get-out-of-jail free card if denied or delayed treatment harms an injured worker.
In 2007 Texas passed legislation prohibiting non-Texas licensed doctors from doing utilization review in Texas. Here's the quizzical situation as it stands now: a California doctor without a Texas license may not do utilization review in Texas, but a Texas doctor without a California license may do utilization review in California.
California loses out because doctors without California licenses do not pay licensure fees to the Medical Board of California.
California's injured workers lose out because of arbitrary and unilateral delays and denials of treatment.
Interestingly, The Zenith and the State Compensation Insurance Fund do NOT use doctors without California licenses.
The insurance industry asserts that the use of non-California licensed doctors is needed because there are not enough California doctors to do the job. This assertion is also false, e.g., E.K. Health has a waiting list of California doctors applying for jobs as utilization reviewers.
The point is that California licensure for utilization review doctors should be required by law, the loophole insurance companies use to get around this requirement should be closed, and if a utilization review doctor wants to live on the moon, that should be allowed. the doctor should be licensed in California nonetheless.
Dr. Robert Weinmann, past President of the Union of American Physicians and Dentists (UAPD) has a private neurology and pain management practice in San Jose. He is currently president of the UAPD Independent Practice Association. He has provided dynamic and effective testimony before the United States Congress and the California Legislature on matters of healthcare, patients’ and physicians' rights, Medicare, and antitrust reform. Weinmann has received awards from the United States Congress and the California Assembly, and at the invitation of former President Bill Clinton was featured as a speaker at the White House on managed care. He points out that his public policy agitation in healthcare is bipartisan.
Comments
I applaud your comments and efforts in California. I am hoping to establish similar legislation in Illinois which constantly gets hammered by UR decisions from companies based in AZ, TX and CA where there is no licensure in Il. The points you make are valid and all UR physicians should be held to standard of care for the region in which they opine. If they fail to meet the standard they should be subject to medical malpractice.
Posted by: Jesse Butler,MD at September 15, 2009 08:14 PM
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