Q: What if the Agreed Medical Evaluator (AME) or Panel Qualified Medical Evaluator (PQME) in my case said I needed the treatment that Utilization Review (UR) denied or Independent Medical Review (IMR) upheld?
A:
The law has changed such that once a valid UR denial, and following that a valid IMR decision upholding that denial has been issued, the AME or PQME cannot comment on the necessity of that treatment or enforce your ability to receive that treatment.
