What Happens If The Defense Base Act Insurance Company Won't Authorize My Medical Treatment?

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The Defense Base Act Adjuster Won't Authorize My Free Choice Of Physician

Sometimes, the DBA insurance company will either not authorize your free choice physician or they will only authorize treatment with a doctor of their choosing. Either way, you need to make a record. Meaning, document what is happening to you.

A letter with a proof of service or an email will do. Be sure to keep a copy of your letter and proof of service. With email, be sure to send a copy to yourself also, so you can prove you emailed your request to the DBA adjuster.

Your letter/ email needs to say something like this:

"Re: 11-7-2011 Afghanistan DBA Injury - XYZ Security Co.

Please be respectfully advised that I hereby choose the following physician to be my free choice physician:

Dr. Cindy Hugeheart Orthopedic Surgeon 101 Hospital Lane Anywhere, My State (555) 555-5555

Please authorize evaluation/ treatment.

Please advise.

Thanks,

Dave B. Hurting"

I would recommend sending the email two times. Unless, you require emergency medical care (in which case, you should just go to your local emergency room); you need to give the adjuster a few weeks to approve.

Now, let's say that the adjuster either denies authorization or ignores your request or both. Then, again, you also have to document what is happening. I suggest sending the DBA adjuster an email something along these lines:

"Re: 11-7-2011 Afghanistan DBA Injury - XYZ Security Co.

Please recall that I have sent you two previous emails requesting authorization for evaluation/ treatment with Dr. Hugeheart. Since you have not authorized evaluation/ treatment with Dr. Hugeheart, I will have to seek treatment for my DBA injury from my wife's private health insurance - Acme Health Works. Please be advised that the doctors at Acme are not my free choice physicians. I am forced to see the Acme doctors because I don't have other means to receive medical treatment for my DBA related injuries.

In the alternative, if you immediately authorize Dr. Hugeheart, I will not have to incur the expense of treating at Acme.

Please advise.

Thanks,

Dave B. Hurting"

While there are no guarantees in life or DBA cases, this approach will probably allow you to treat with Kaiser and not have the Judge later rule that you exercised your free choice of physician when you chose to be treated by the Kaiser doctors.

Disclaimer

This article is not legal advice. I am simplistic in order to achieve clarity. If you are a seriously injured DBA worker, you need to hire the best DBA lawyer you can find. Always tell the truth when you bring a DBA case.

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