What’s a Request for Authorization (RFA)? Understanding in Simple Terms

By California law, EVERY medical treatment recommendation of your doctor must be on a one-page Request for Authorization (RFA) and forwarded to the proper place for consideration by the claims administrator. From there, the RFA will either be approved or sent to a Utilization Review company which will ether approve or deny the request. Let’s break this process down for easy understanding.

Asking Permission For Treatment

An RFA is like asking for permission to get specific medical treatment, for example, medication, physical therapy, and even surgery.  Your doctor fills out the RFA and sends it to the insurance company for review.

The Insurance Company’s Decision

Once the insurance company gets the RFA, they will decide whether they feel the treatment is necessary. If the claims administrator (adjuster) approves the requested treatment, the doctor can proceed with the treatment. However, if the claims administrator does not approve the treatment, the adjuster MUST forward the request to a Utilization Review (UR) company who will arrange to have a physician review the RFA and decide whether to approve or deny the requests. UR might ask for more info from your doctor. If the treatment request is properly denied, the physician cannot ask for the treatment again for one year – but there are exceptions to this rule.

Connect with Thomas F. Martin, PLC

Remember, if you’re ever confused about RFAs or facing challenges in getting the treatment you need and your doctor believes is necessary, you’re not alone. It is frustrating to face a situation where a physician licensed by the State of California to treat patients can’t do so because a UR doctor – who hasn’t even examined you – has denied the requested treatment. For over 30 years,  Thomas F. Martin, PLC has fought to obtain the treatment that his clients want and need to heal from their work injuries.  Don’t hesitate to reach out for assistance or call 714-547-5025 for a free consultation.