Just keeps piling up!!!!!! - Printable Version
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Just keeps piling up!!!!!! - capricorn - 09-18-2007 10:24 AM
I finally found this facility that I love for PT and was sent home last week before an eval of the lower body was even done because the A&^*()__) adjuster told the facility that the Judge changed his mind in deciding in my behalf. All lies! My claim is still approved but now the facility won't see me unless I use my personal health insurance. They THINK this will guarantee payment. My personal health insurance won't pay crap anymore because they knowit's all WC related and that I won my case. Why should they pay. The biller at the facility told me last week that I could finish out the next two weeks on my shoulder until I see the surgeon an when I got there today for my scheduled appt was snet home because they didn't have a referrel from my personal health insurance. DOes anyone else think this is funny as they do??? to have someone in pain drive to a facility to be sent home twice in a couple of days. I asked 2 people why they couldn't call and was told they didn't know. BS. All of a sudden they all found out 5 minutes before I got there>>> SO just as I start making headway with my shoulder I will do without any PT for two weeks until I can see the new Dr. I also have an IME this week and am so afraid I will blow on him.
Thanks all for caring!
RE: Just keeps piling up!!!!!! - ksgirl - 09-18-2007 10:40 AM
Cap, that is pure bull!!! Do you have an attorney? If you do, get on him, if you don't call the adjusters supervisor and ask just what in the h#!l is going on. If you have already won the right to treatment you should be getting actual medical treatment. Not the type of treatment you are getting!
RE: Just keeps piling up!!!!!! - capricorn - 09-18-2007 10:53 AM
Yep ksgirl, have an attorney. From what he told me she did nothing wrong but lie. Unless they submit a bill and she refuses to pay it there is nothing he can do just because she's a B&^*(&^. I know several people who have had to deal with her and they all said the same thing about her. She is a miserable B*&^(). So now I am kind of stuck with no treatment until I can get in to see the PM Dr. on Oct 1st. I just hope my arm doesn't get any worse. I can only do so much on my own. When I was injured it involved my neck, back, shoulder, knee and ankle. Have had no PT on back or knee. Was supposed to start that last week and was denied. My neck is in spasms from the PT on my shoulder and the main symptom I have in my knee is that it gives out and I roll over on my ankle and twist my back. I have been very careful to walk carefully BUT all of a sudden I have a lot of pain on the inside of my knee and straight down the front of my knee cap. Neck, shoulder and knee are in a lot of pain. No meds. The only parts that are in pain but tolerable are my back and ankle. I am getting closer and closer to either giving up OR getting nasty. What am I supposed to say to the IME this week if/when he asks if I'm in PT. " I was but then the ignorant adjuster screwed me out of what was rightfully mine and now I have to wait two weeks"??? Because that's what I am afraid I am going to say.
Thanks ksgirl, for responding. I don't think I can take much more.
RE: Just keeps piling up!!!!!! - Timothy Belt - 09-18-2007 02:08 PM
I am not trying to second guess your lawyer who has full access to your file, but I would consider a petition for penalties. There are several cases on this issue such as Loose v. WCAB (John H. Smith Arco Station), 601 A.2d 491 (Pa. Cmwlth. 1991) finding an employer is subject to penalties where it unilaterally ceases payment of medical expenses and fails to file a petition to review the reasonableness and/or necessity of those expenses, or McLaughlin v. WCAB 808 A.2d 209 (Pa. Cmwlth. 2002) where a penalty was assessed for the carriers failure to authorize the employee's treatment without filing a UR. Your facts sound similar to McLaughlin.
RE: Just keeps piling up!!!!!! - ksgirl - 09-18-2007 02:12 PM
Cap, have you told the Dr that ordered pt what the adjuster is doing? Maybe that dr can help. Or have your lawyer call the pt place and try to explain to them that wc will be paying. If the IME dr asks about pt I would tell him exactly what you wrote here. Good luck and get nasty if you need to!
RE: Just keeps piling up!!!!!! - capricorn - 09-19-2007 09:28 AM
Thanks ksgirl......Attorney told me to have them call him and he would verify BUT as far as he's concerned this should have never happened and asked me if I felt this was the best place for me for the long haul IF after a month of PT they are already putting me in the middle. The sad part is that they have already gotten paid so I have no idea why they started this crap with the lower body. I explained to them that IF they didn't get paid the Adjuster/IC would be penalized and asked them if they wanted of copy of the top page of the Judge's orders. I also explained that in my state pre-authorization is not legal and she said that's not why she called but had no explanation why she did. So you see , my attorney is right. I need to move on to a PM dr. Right now I am seeing all surgeons and since one doesn't believe I need anymore surgeries I don't think it's necessary to have surgeons treating me. I have never had an MRI done on my kee since the first injury in '04 and no PT. It's still buckling but now is in pain constantly. So I think the change in Dr.s will be good for me.
I can't sleep again since this happened, have been fighting with hubby constantly, quit smoking 6 1/2 weeks ago and want to start again, am miserable, talk to no one but my family here so I really am afraid that I will blow or cry or something on this IME tomorrow and you know what my friend??? I don't care anymore. No one should go through this. You work all your life and this is what you get. Thanks for caring.
RE: Just keeps piling up!!!!!! - Still in Limbo - 09-19-2007 09:30 AM
Cap., Tim and Ks have both given you great info. A Letter from Your attorney with a copy of the judges ruling should start Your PT again, it's basically a Guarantee they will get their Money, and if the Adjuster stopped Your PT even if it's with a Lie, they can be Penalized for it. If you work in those two areas, You should be able to get Your PT back Pretty Quick!!
RE: Just keeps piling up!!!!!! - capricorn - 09-19-2007 11:15 AM
Thanks Limbo...I have decided to go to the PM Dr. He has his own PT. I saw this guy when first injured and was not crazy about the PT but will give him another try. He always seemd to be too busy, have too many patients at once. It could have been my mood also at the time that made me feel ignored/overwelmed by so many hurting body patrs. The one thing I do know is that they will not leave me out in the cold like these people did. I can't get an appt. before Oct 1st but am on the cancellation list. Need to have an MRI of my knee done since the last one was in '04 and besides the fact that it buckles and causes me to fall , now I am in pain. Thanks my friend.
RE: Just keeps piling up!!!!!! - Pooh - 09-19-2007 11:21 AM
when you go to the IME and he asks about PT - tell him the truth - that the adjusted denied your PT at this point.
RE: Just keeps piling up!!!!!! - capricorn - 09-19-2007 12:03 PM
Hi Pooh...That's my plan. I called the paralegal this morning and told her I need coached on this IME tomorrow as I am in a really bad frame of mind and have no idea how I'll react/act. Well she must have told my attorney because he called and said he is calling the attorney for the IC to see just what the H*() is going on. I needed ride to this appt. although hubby was going to come with me to help me get changed if needed and at first I was told that's fine now the co, called and told me what time they would be picking me up and that no one can go but me. It's OK. I'm a big girl BUT without his support on the way I will probably end up crying on the IME and just telling him I have been in so much pain in so many body parts for so long and have been thrown around like a rag doll that I just don't know what to do anymore. I've had it.
Tim....Attorney must have re-thought his decision about not ignoring this. I think his reasoning was it was time to change Dr.s since my treating Dr. s are both surgeon's and I don't need anymore surgery. So I will see the PM Dr. for a second opinion and hope to treat with him as well. When my attorney called today he was annoyed and calling the IC attorney. Wish he would have listened to me in the first place. I guess the mention of me messing this IME up got him to listen