UR Data in Bill Analysis Highlights Need for Good Data

By Greg Jones, Western Bureau ChiefThe cost effectiveness of utilization review is a crucial issue for stakeholders as California embarks on another reform effort, but state regulators can provide no clear answers when asked how often UR results in medical treatment being denied.A legislative analyst said that between 6% and 20% of utilization review requests are denied, in a report on the potential impact of a bill that would authorize attorney fees for applicants' attorneys who overturn UR denials. The analyst concluded that the bill would not significantly increase costs because of the ...