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Author Topic: OMG, they are driving me nuts!  (Read 2175 times)

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Offline saralyn

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OMG, they are driving me nuts!
« on: May 13, 2003, 11:58:11 PM »
 Mr Dr faxed over a note to WC explaining why I was being referred to OS, WC now says not good enough, they want more details, so now My dr will fax over detailed info such as knee is still swelling, painful, giving out on me etc.... WC lady told me well you can just go to the OS & we'll reimburse you after we approve the visit,that way you can keep the appt. I explained to her I have no $$ because you at WC have not paid my claim yet(why I got an ATTY, you muttonhead,didn't say that but wanted to..), so WC says they can't do anything without further info, my Dr sent then everything & bottom line is he is a GP & doesn't do knees, wants me to see an OS, DUH! Why are they being so difficult? Then she tells me I was non compliant with pt & I said no I went to pt, but missed 2 visits due to my Mother in law having a heart attack & being in ICU for 4 days & I called the WC nurse & told her the day this happened), & then my Dr said not to go anymore until they find out what the exact injury is,,, round & round we go in circles. Now I'm frustrated & called my lawyer, I'm so sick of this, some please advise me if you have been down this road, this is a top ten university here in Mich that  I am dealing with, how do you deal with the big dogs who just don't care? Okay, I am done ranting now & thank you for reading if you got this far,lol. How bad is this my S-son just poured me a glass of wine at 4pm,  :P! What a good young man.
saralyn
direct blow to kneecap  on concrete 3/16/03,swelling & pain continue,extent of injury still unknown.

Offline lizl

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Re: OMG, they are driving me nuts!
« Reply #1 on: May 14, 2003, 04:39:06 AM »
Drink the wine and leave the wrangling to the lawyer!

Don't let 'em get ya down! I hope it all gets better soon.

That whole non-compliant thing with PT is interesting.  WC is insisting you go to PT without even having a complete diagnosis! Then they won't approve the OS appointment! It's classic Catch 99 and circular reasoning (or lack of reasoning). This is the sort of thing lawyers specialize in!

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March

Offline Rich_NYC

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Re: OMG, they are driving me nuts!
« Reply #2 on: May 14, 2003, 08:01:30 AM »
Hi
LizL has the right idea.  Sometimes all you can do is have a glass of wine, sit back and contemplate the absurdity of the modern world ;) ;D.  Social Security disability claims are just as bad.  The most important piece of advice I can give you is follow through to the end, win or lose.  Sometimes I think they mess with people to try and scare you away >:(.  I wish you luck in the struggle.
Rich
scope to repair 2 meniscal tears (didn't help the pain]; post-patellar osteoarthritis

Offline neil

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Re: OMG, they are driving me nuts!
« Reply #3 on: May 14, 2003, 08:33:06 AM »
hi
i understand your frustrations. i am in middle of wc case right now. with your lawyer, i would think the ins co would no longer deal with you, only the atty this way there is no chance for who said what. that is how mine is.  legal issues i guees. but with that i have felt the frustration, and it is hard because we are just claim numbers, pieces of paper on someones desk.  i have learned to let my attny do the worrying and me the healing.  when wc canceled pt and  surgery on me i continued to do what i had learned in pt, a call to atty , a visit to my wc hand picked os to evaluate me , then i finally was back in pt and had the surgery 2 weeks ago. wc wanted me out of hospital as soon as possible and they have limited , put time limits on how long i can have certain pieces of helpful equip (cpm machine, empi /e stim unit) all beneficial to my recovey and you would think that is what they would want. quicker they diagnose and take action less it cost them. hard to understand why they do not do that, but i no longer worry because i can only do what i can do. keep your chin up and keep track of everything and remember to get reimbursed for any thing related to your wc case. they won't reimburse you if you do not seek it.
wish you the best
neil
9-13-02 - present, 4 surgeries to right knee. quad severed, piece of femoral condyle cut off, shaving of patella. had cartilage implant 9-22-03, fluid drain, cultures & manipulation10-21-03

Offline Janet

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Re: OMG, they are driving me nuts!
« Reply #4 on: May 14, 2003, 04:50:24 PM »
Where is your attorney in all this? You should not have to fighting with WC, he should be doing it for you. Isn't the stress just unbelievable? I've been really lucky with my WC. I never had a problem through three years with them. They covered everything and never questioned anything. Then my adjuster left and I was assigned a new one. Nothing but problems since then. I am now waiting to see if they'll cover my next surgery (#4). But I'm lucky because I have private insurance that will cover the medical costs and my employer will continue to pay me. But it's the principle of the thing. WC should cover it because it is their responsibility. My employer should not have to pay, and they have written a letter to WC to that effect. Anyway, good luck. Try to keep your stress level down as much as possible. I know visits to major university doctors can be expensive. My first visit (with 2 x-rays) at U of M was $475!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Squrll54

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Re: OMG, they are driving me nuts!
« Reply #5 on: May 14, 2003, 07:48:40 PM »
I feel your pain!!!  The insurance co. (wc) is playing a simular game with me as well. They postponed my original surgery so they can suppositly geta second oppinion, but the real case was so they can do survaliance on me.  They were proved wrong and now I just had my surgery last thursday, after a month of being in pain walking around and up and down stairs. I was luckey though, there doc stuck up for me and told the truth that I needed the surgery.

I do not understand the workers comp people!  If they would just let people get done the stuff they need, without all the frustration, people would not be forced to go out and get Lawyers.  I know I was not going to get one until they started to really screw with me.  I.E. the survalence  the weeks of not getting paid,  all the changed doctors appointments, the cancelled surgery .

It is all there fault!

Just ranting my self

Offline saralyn

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Re: OMG, they are driving me nuts!
« Reply #6 on: May 14, 2003, 10:20:32 PM »
Hi All,
Thanks for the advice & kind words. More of the same crapola today, the WC person says they will not pay for a OS consultation as they need more dictation from my Dr, which he has provided twice now. She said Ishould not deny myself medical treatment though,lol. Well, I asked her then since I have no ins & you will not authorize a OS, how about I come sit in the ER there at U of M since that's where the injury occured & get treatment there, she stated that I should seek treatment outside the U of M system since I had been discharged to my own Dr.s care, Ummm I did go to my Dr, he is referring me to another Dr, what is so difficult to understand about that?  The accident occured in front of 2 witnesses & they have an incident report filled out the very day it happened! -What next... my atty says to go to the appt with the OS & pay for it myself, but I don't have the $$, they really have me in between a rock & a hard place, it makes me so upset...then she says I am not entitled to any benefits as I resigned voluntarily, I told her it was not voluntarily, my boss stated she couldn't keep accomidating my injury- in front of witnesses no less,that's why I have an atty. She said again she at this time could not substantiate any claims for my case, & yet they paid for an mri..so my Dr.s nurse is once again calling them to find out exactly what they want ot approve this visit.....this lady also said she never recieved any of the faxes my Dr sent! Perhaps I should have my Hubby hand deliver them?
Is it always like this with WC? Thank you if you got through this rant too ::)
Saralyn
direct blow to kneecap  on concrete 3/16/03,swelling & pain continue,extent of injury still unknown.

Offline saralyn

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Re: OMG, they are driving me nuts!
« Reply #7 on: May 14, 2003, 10:23:07 PM »
Lizl,
Yes you make a very good point about the PT thing, as they still dont seem to be interested in getting a complete diagnosis, I will mention that to my atty..Thanks.
Saralyn
direct blow to kneecap  on concrete 3/16/03,swelling & pain continue,extent of injury still unknown.

Offline saralyn

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Re: OMG, they are driving me nuts!
« Reply #8 on: May 14, 2003, 11:46:45 PM »
Well, My Dr called & spoke with the lady (and I use the term lady loosely) & she stated since my mri report stated it was a old injury & they were not going to pay any more claims on my knee injury. My Dr explained that the injury occured 7 weeks prior to the mri & they said, we consider this a closed case &  that's the end of it....So tomorrow I am picking up my records from my Dr. & taking them to the OS the first week of June... so that's the latest.......Thanks all for all your great advice..
Saralyn
« Last Edit: May 14, 2003, 11:47:17 PM by saralyn »
direct blow to kneecap  on concrete 3/16/03,swelling & pain continue,extent of injury still unknown.

Offline lizl

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Re: OMG, they are driving me nuts!
« Reply #9 on: May 15, 2003, 12:06:30 AM »
Saralyn,

You're welcome! I aim to please. . .

I agree with others here who have said that your attorney should be communicating with WC.  I got a lawyer early on, not because WC was refusing my treatment--but because they phoned me two or three times a day to see how I was "doing." Even while in the hospital, I felt a great deal of pressure to tell them I was doing well, though I certainly was not. I suppose that could have meant they cared a great deal about my well-being, very uncharacteristic for an insurance company.

My wise brother convinced me that there were only two reasons for such intensity: 1--they were trying to wrap up my case quickly, perhaps by  getting me to be overly-complacent or trusting; or 2--they knew my injury was going to be troublesome, and they wanted to convince me that they were my friends. In either case, I needed a lawyer; and quite frankly, I was starting to be afraid that all of the questions (especially when they were repetitive) were a way to get me to say or do something that would hurt my cause and marginalize their liability. Of course, I was in a lot of pain and under stress.

Immediately after our first meeting, my lawyer contacted every one who had called me and told them to direct questions to him.  The phone calls are now very few and far between, and they concern things like arranging for the wheelchair to go back to the rental agency. WC does still phone my doctor after each of my appointments.  I only know that because I saw something written on my chart and I inquired. I know that they have also talked to the PT. I am almost amused by the trail of paperwork they must have by now!

In short, WC is going to be intrusive to one degree or another. You might as well try to limit it by having the lawyer do some of the communicating. It looks to me like they don't want a clear, fast diagnosis, because that makes them culpable. Regardless of how serious your injuries eventually turn out to be, it seems clear that WC is obligated to pay for the diagnosis. That incident report is your insurance, and your lawyer should be the one to make that point with WC.  

By the way, has anyone tried going over the head of the flunkie who is passing down these edicts? Have you tried the "I need to speak with your supervisor" tactic? Sometimes it even helps to go up more than one level. Eventually, they understand that you are not going away (again, something lawyers do best). :o

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March

Offline saralyn

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Re: OMG, they are driving me nuts!
« Reply #10 on: May 15, 2003, 12:24:35 AM »
Hi There, well I have tried the let me talk to the supervisor, but it's funny how the supervisor is never there, I think from here on out I am done communicating with WC as she has told my dr they will not pay for any more claims on this( I thought the incident report was for my protection also?), sooo I think I will take your advice & let the atty handle it, though his advice is to pay out of pocket then really slam them with a civil suit in addition to the wc , after the OS gives an actual diagnosis. Though it is really hard to come up with that much $, however after I explained the situation the OS said after I pay the 1st $115 he is willing to take payments for the xrays & such, which is very nice of him. The OS also said whatever radiologist read my mri should have never used the term old injury as there isnt any way to tell how old an injury is on an mri, only if it is scar tissue & things like that which he said I could have had at 7 weeks, he also doesnt understand why xrays were never done when it happened but says he will do them right in the office when I go in, so in that respect Im relieved, but still having pain & the nail beds of my 1st two toes on that foot intermittently turn blue? ah well, makes for nice conversation doesn't it? lol, at least even though I don't like the way things have gone with WC, I know which direction I have to go now & I don't have to argue every little thing with that WC lady  on a sometimes thrice daily basis...so just a little more waiting I suppose.....I do appreciate your input, as it is so frustrating, my Dr thinks I may have a fx patella & maybe bone fragments are causing the swelling & grinding which doesnt always show well on mri's he said? Any how, that's how it all shakes out today, ho-hum.. ::)
Saralyn
direct blow to kneecap  on concrete 3/16/03,swelling & pain continue,extent of injury still unknown.