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Author Topic: Now what?  (Read 1586 times)

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Offline Flame

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Now what?
« on: April 17, 2006, 11:41:58 PM »
I spoke with my attorney today and he said that there is nothing he can do for me. I go for my mmi on the 28th and that will be it. They have denied my surgery for about a year and a half and now here I am at the end of two years and I'm still not fixed. They would rather pay me for the rest of my days then fix the problem. I was told that I have lifetime medical for my knee, without the surgery, and they would pay for the meds too. I HATE these people! They said that the reason they will not do the surg is because the ins company said that there has not been a significant change in my medical condition. Well H*LL no there hasnt been cause they havent done anything! My last surgeon pretty much screwed me on all this and there is nothing I can do about it because of the laws here.

Sorry about all this guys. I have sat and cried for most of the afternoon today and I am at a loss right now with everything. I have lost everything since all this has come about. I had to move back in with my parents also. Dont get me wrong, I love my parents to death, but I am 34 yrs old and I get along with them much better when I dont live there. I have started looking for a job but I have no real office skills and I cant go back to the same type of work I was doing before.I cant stand up for that long. I'm just really scared about what's going to happen next. I still have therapy twice a week but how is that going to work out if, or should I say when I get a job? I wont be able to go to therapy anymore. I'm feeling very confused about al this. I know that after I get some sleep and stop crying about it that i will be able to think straight.

Thanks for listening guys.

Laura

knee deep in Goo

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Re: Now what?
« Reply #1 on: April 19, 2006, 12:39:28 AM »
Laura,

Breathe -- Something will come your way.  I am about the same age as you and .. I will tell you .. the thought of loosing my job because I have a poor knee future.. Kind of scares me to death.  This is a time when you need to take a deep breath and let all the stress out. Its really hard to express to people who do not have knee problems or had any type of cronic pain .. what your day to day is and .. I have found when you start to express all that is going on they look at you freaky .. .. So i started to rethink my own world today and thought >. I  need to be accountable to only myself and what will bring me back to a normal out of crappy knee land mindset.    My new outlook created today will conssit of a new phrase.. I am getting better daily and this is what I did for myself today..   

First thing I did for myself today .. I used my cane instead of my crutches to get into the office at work
Second thing I did for myself today is I checked out the recumbent bike in the workout room prior to my lunch break and did a five minute bike ride.   ( hell people take pee breaks for more than five minutes sometimes and sometimes they smoke for more than five minutes)
Third thing I did for myself today. Instead of sitting at my desk skipping lunch.. I went and bought an ice pack and .. got a nice cup of coffee from dunkin donuts.
Fourth thing is .. before leaving work today.. with the cane.. i sat down for two seconds  before leaving the building.. I had to allow myself that..


I really think the mindset of insurance companies is you have to get worse before your allowed to get better.

And when you do get a job.. perhaps you can go to a gym that has late hours or weekend hours... or even get good enough at your excercises that you can start doing them at home..

Offline Nettan

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Re: Now what?
« Reply #2 on: April 19, 2006, 06:30:24 AM »
Laura, is there somehow something the docs have missed to write down ?
I mean can they confirm on paper that you are worse off now ?
Sometimes these insurance companies can be very tricky when it comes to a little note.
I really wonder if paying you rest of your life will be cheaper then doing the surgery.
Wish I had some clue to help you out. Is there any forum for patients in your country which can help you ?
Don't give up Laura, hang in there. We have to put our heads together to find a way to help you.
HUGS TO YOU FROM ME !!

NETTAN  8)


Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline momof2

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Re: Now what?
« Reply #3 on: April 19, 2006, 06:56:30 AM »
Laura,

Have you appealed the denial to a peer review by an orthopedic surgeon that specializes in only knee injuries or even more detailed injured knee specific to your type of injury.  I am not sure of what your injury is because I am new to the boards.  I work in the work comp industry in california and you should have some sort of recourse.  You may need to consider a new attorney.  I had an ankle injury that was work related and the attorney got tired of dealing with me and tried to settle out the claim.  Ultimately I changed attorneys and received the medical care that I needed. 
3/10/06-ACL reconstruction with allograft,partial medial menisectomy,chondroplasty, extensive 3 compartment synovectomy/debridement,resection of hypertrophic synovial plica-right knee
9/15/06-partial medial menisectomy,chondroplasty, extensive 3 compart. synovectomy/debridement of the left knee

Offline Flame

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Re: Now what?
« Reply #4 on: April 19, 2006, 08:10:10 AM »
Knee Deep-

Thank you for the encouraging words. i really needed to hear them. Some days are easier than others. Most of the time, I am in a pretty good mood. Lately here though it has been very hard with everything going on. The stress is just strating to get to me again. I know it will pass.

Nettan-

You have been so helpful and good to me! The drs have everything written down. I can be confirmed on paper but the ins co is just not listening. As far as forums go, this is the best one I have found. Hugs back to you too!!!

momof2-

Yes I have appealed to the peer review and it is getting me no where. From what my understanding was, I have one of the best attorneys. I have been thinking about a new attorney and new drs though. Its not him though. The ins co said that there has been no change in my condition. See, my last surgeon (2 surgeons, 3 surgeries) just kindof "wrote me off". We had a altercation in his office because he would not shut up long enough to listen to me. So I fired him and he released me back to work full duty, no restrictions. He was not my treating dr and since then I have had nothing but trouble. All the ins co wants to look at is his paperwork. I have been to the DD 3 times already and she said that I have not reached mmi. She has even said in her reports that I need the surg. My papers that were reviewed by the peer review said that I need patella femoral resurfacing. ( I think thats what they said I dont have them right here in front of me right now) That surgery was requested and then denied. It has been appealed several times and the last time it was requeated, it was ignored. My dr was going to file an appeal and a complaint. The ins co dr (the one that is reviewing the paperwork) from what I understand is a real BUTT! My attorney said that in this field office all the do hearings for is backs and necks. Just a big pile of DOO! I try to keep my cool with all of them but the drs who are trying to help me usually end up getting fussed at. ( I always apologise) I just dont understand all this though! Why wont they fix it?

(sorry this is so long)

Laura

Offline momof2

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Re: Now what?
« Reply #5 on: April 20, 2006, 03:43:42 AM »
I am so sorry to hear that they are not listening.  Do you have a work comp appeals board in your state.  Sometimes it helps to contact them and file a complaint against the insurance company.  Unfortunately I am in
California so I do not know the laws or regulations in your state.  What I do know is that there is usually away around everything in the work comp system it is just a matter of finding the loop.  In addition it is not uncommon for them to deny things in hopes that you will just give up.  Has your attorney mentioned an Agreed medical examiner?
3/10/06-ACL reconstruction with allograft,partial medial menisectomy,chondroplasty, extensive 3 compartment synovectomy/debridement,resection of hypertrophic synovial plica-right knee
9/15/06-partial medial menisectomy,chondroplasty, extensive 3 compart. synovectomy/debridement of the left knee

Offline Flame

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Re: Now what?
« Reply #6 on: April 20, 2006, 01:33:11 PM »
No, I havent heard of that one. With this particular injury it has been two years on the 30th. I am going for treatment today and I am going to see if there is something else I can do, or someone else I can talk to. Thank you for all your help. O really appreciate it.

Laura

Offline bikersmurf

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Re: Now what?
« Reply #7 on: April 20, 2006, 08:34:21 PM »
Hey!
 I can not tell you how much I feel for you and outraged at the system. I have a simular attitude and I think they  need a slight injury to get just a hint.  I have a friend that went through a simular thing and she went to local congresssmen office and went and contact local branch of human rights office and the head of medical board for her hospital. She also contacted the insurance company main office and requested a new hearing with the grounds of byass on the part of the dession board. Then she wrote her story to a health reporter at newspaper and they got involved and bashed insurance company and after awhile she got het op. I know it sounds exstreme, but anything you can do to expose them and you can keep your self hidden from public will help. I wonder are you on disability. Thay wanted to just pay her and she got a settlement disability and full medical. Your lawyer seems like he is just not into helping much. I also wonder if you could have a knee replacement?. Also  bring into fact you are liable to anyone who hires you and now with out it you are helpless to afford to live. Get you local dept of sosial services(medicade) involved, they could felp force them to help more. I hope you can figure something out and if you need to vent or help I am here for you. These insurance companies need to get knocked down a few pegs, also check the articles and etc on your injuries, see if they have come up with treratment options or even if they are looking for people for studies. Anyways Good luck and I am thinking of you.
Bikersmurf
Motorcycle accident(open patella shattered)
8-05 reconstruction surgery wires pins, crown and figure eight , FEb 06, had bad fall and damaged knee and hardware. May 5 06 op to remove hardware and repair tissue, quad and nerve damage. Recovering!!

Offline Flame

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Re: Now what?
« Reply #8 on: April 21, 2006, 03:50:32 PM »
Bikersmurf (what a cute name ;))-

Thank you. I am actually going today to the congressmans office. He is about 2 miles down the road from where I live. As far as the medicaid people go the can all .....well, you know! They said that I cannot receive anything from them because my kids dont live with me but my kids dont live with my because of my physical problems. I am really tired. I just want it all to go away but I am going to make some people very unhappy today. I have already decided that. Once I get the congressman involved with all this and I show him my files, I think that maybe the ball will start rolling again. I am going to be making a big stink over here!!

Laura