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+--- Thread: A crazy morning, the Dr. appointment that didn't happen! (/showthread.php?tid=6663)
A crazy morning, the Dr. appointment that didn't happen! - Bummer Knees - 02-11-2009 03:23 PM
I had a left knee replacement last summer, today was the 6 month appointment. Today's appointment was scheduled at the request of the doctor's nurse.
When I got to the appointment the receptionist said the doctor's notes say you do not see the doctor until June, I will have to call your case manager.
When the receptionst got off the phone she said, the case manager will only approve treatment of your right knee. I told her that the doctor is only authorized to treat the left knee, the one with the replacement.
She then gave me a copy of a fax from the case manager.
It reads:
Per our conversation, we are authorizing treatment of the right knee only. We are denying left knee treatment at this point.
I read the fax and told the receptionist to look thru my medical records for the court order of medical treatment for the left knee
(I do have an IME schedule for next month for treatment for the right Knee)
After reading the court order the doctor's nurse said my file will be turned over to the administrator to determine if the doctor can see me again.
I have an appointment scheduled with my attorney for Monday morning.
RE: A crazy morning, the Dr. appointment that didn't happen! - 1171 - 02-11-2009 03:37 PM
get a copy of that fax. It'll be great evidence for penalty on treatment denial.
RE: A crazy morning, the Dr. appointment that didn't happen! - Bummer Knees - 02-11-2009 04:01 PM
1171
I have a copy of the fax and will give it to my attorney Monday morning.
RE: A crazy morning, the Dr. appointment that didn't happen! - Bad Boy Bad Boy - 02-11-2009 05:00 PM
I'm sorry Bummer, but your Surgeon knows you have to perform the 6 month, and 1 year follow ups. With X-Rays. This is standard protocol for a knee replacement. Then follow - ups every year after. Hopefully when you settle, you remember to get a medical calulator for the yearly visits added in to the settlement.
RE: A crazy morning, the Dr. appointment that didn't happen! - Bummer Knees - 02-11-2009 05:49 PM
Bad Boy
I have never been told how often I need to see the doctor after the replacement.
I have read this doctor's web site and nothing is posted about follow-up visits and when they should happen.
The doctor's nurse told me me this morning, "We can not see you unless work comp approves it."
Fact is the insurance company in now in violation of a court order by denial of medical treatment.
RE: A crazy morning, the Dr. appointment that didn't happen! - halftrak - 02-11-2009 06:19 PM
kind of crappy of them not to have least called you ahead of time, at least it wouldn't been a wasted trip for you.Sorry Bummer, you are having such a hard time with all of this.
RE: A crazy morning, the Dr. appointment that didn't happen! - Still in Limbo - 02-12-2009 11:31 AM
Your Attorney should be able to get You some Penalty Monies Based on them not Following a Court Order. So Far, in My Case, I have Received $11,000.00 in Penalty Monies from the i/c for not Following the w/c Rules of Pa., and also the Judges Orders. I also have More Penalty Monies with Interest Coming after I won a Section of My Appeal. What's Funny about ALL of this for Me is I Offered a Settlement before We EVER went to the First Hearing, Well over 3 Years Ago, and they have already Paid Me More than that in Weekly TTD and Penalties and Interest!!! And My Attorney Assures Me that the Original Amount I asked for is Out the Window, should We get into Negotiations to Settle! That's a True Waste of Money, but that's how this System Works. What I have done is Figure Out how to Make them Pay More than they want by Court Orders, with Interest, because they want to Play Games with Me!! It's Amazing to Watch, and even though there is No Amount of Money that is worth this Pain, and I would Love to be Working again, I'm making them Pay for any Little Mistake they Make!! Best of Luck, and I Hope You get this Resolved!!
RE: A crazy morning, the Dr. appointment that didn't happen! - Bummer Knees - 02-12-2009 12:24 PM
Thank you Still In Limbo & Halftrak
Today I wait for a phone call from the doctor's nurse to see if the surgeon that did my knee replacement will see me in the future, (If work comp allows)
I wonder how the judge will react to this when we go back to court in a few weeks to add the back and carpal tunnel to the claim.
I really don't think she will be happy when she finds the insurance company has denied medical treatment that was granted by her court order.
RE: A crazy morning, the Dr. appointment that didn't happen! - halftrak - 02-12-2009 12:32 PM
you know when I was supposed to have my second shoulder surgery, I actually went to the hospital and they told me that wc had denied my surgery, so I went back to work the next day and wc then sent me to another doctor 100 miles away, 3 weeks later and then they approved the other surgery.My point is that no one not even my lawyer had bothered to tell me that my surgery had been canceled.Do You think that your lawyer should have got with you and told you this or did they not even inform him?If I was you I would Have been pi******.Hope all works out for you.
RE: A crazy morning, the Dr. appointment that didn't happen! - Bad Boy Bad Boy - 02-12-2009 12:36 PM
Their simply going to come back and say it was a Typo error, and they got the knee's mixed up to which one should be treated.
Watch and see.
What they done, was caused a delay till your seen by the IME, to see if you need treatment.
Watch and see.