EBFR accepts all Workers’ Compensation insurance carriers. Please contact EBFR staff if there any difficulties (925-482-8111) or fax denials to (925-482-1166).
Making Referrals to EBFR
EBFR has two levels of programs available for WC patients (provided in both English and Spanish). After evaluation and consultation with PTP, we will make recommendation as to which program is the best fit:
- Functional Restoration Program – most intensive level (three days per week, 6.5 hours per day, for 21 sessions/7 weeks) for multidisciplinary PT, pain psychology, medication/medical, and vocational management; followed by 3 months of once per week Aftercare. Patient returns to PTP for medication/medical management after the 7 week intensive phase, or as scheduled by PTP.
- Pain Coping Skills Group – once per week for 1.5 to 2 hours for 10 weeks; patients participate in psycho-educational group for training in cognitive-behavioral techniques for pain and stress management. No PT/exercise included.
All WC patients must have a written referral from the industrial Treating Physician for an initial multidisciplinary evaluation (please do not request the FRP, just the initial evaluation). After written referral is received (fax 925-482-1166) EBFR staff will call the patient to schedule an evaluation.
A multidisciplinary report will outline the recommended treatment plan.
At that point EBFR staff will take over management of the authorization process.
Treating physician must indicate in writing agreement with the plan.
Getting Referrals Authorized Using MTUS Guidelines
When you have an appropriate patient to refer, please make the referral for an initial multidisciplinary evaluation to determine candidacy. Please do not request the full program (unless already authorized by carrier), instead request an initial evaluation using the following language:
Requesting the Functional Restoration Program Evaluation:
“Request authorization for an initial multidisciplinary evaluation to determine if this patient is an appropriate candidate for a functional restoration program. Per the MTUS Chronic Pain Guidelines (July 18, 2009, p.30-34), this patient is appropriate for initial evaluation because (1) Previous methods of treating chronic pain have been unsuccessful and there is an absence of other options likely to result in significant clinical improvement; (2) The patient has a significant loss of ability to function independently resulting from the chronic pain; (3) The patient is not a candidate where surgery or other treatments would clearly be warranted; (4) The patient exhibits motivation to change. I am now requesting authorization for an initial evaluation by the team at East Bay Functional Restoration to confirm my impression that this patient is appropriate for functional restoration. If appropriate, the EBFR team will then submit a multidisciplinary report outlining in detail the proposed treatment plan, and they will proceed with a formal request for authorization of the FRP.”
Requesting Pain Coping Skills/Early Intervention Evaluation:
“Request authorization for initial psychological consultation at EBFR to determine candidacy for cognitive-behavioral therapy for pain management. Per the MTUS Chronic Pain Guidelines (July 18, 2009, p.100-102), psychological evaluations are generally accepted, well-established diagnostic procedures for patients with chronic pain. A “stepped-care” approach to pain management allows for initial consultation with a psychologist for screening, assessment of goals, and further treatment options, including brief individual or group therapy. This patient is appropriate for initial screening because they continue to experience pain and disability after the usual time of recovery and psychological treatment incorporated into pain treatment has been found to have a positive short-term effect on pain interference and long-term effect on return to work. This patient does meet appropriate selection criteria for initial pain management psychological consultation. This request is not based on a separate psychiatric claim, nor does it initiate a psychiatric claim. Rather, the request arises as part of multidisciplinary pain management for the industrial orthopedic injury.”
Fax denials or requests for further information to 925-482-1166 or call EBFR at 925-482-8111.
Thank you for asking EBFR to assist in the rehabilitation of your