Rotator cuff surgery and Neck sugery

[gowen64]

Update. I had my fusion surgery on 6-11. I am suprised from some of the complications that I have experienced. The first was the inability to swallow at all for the first couple of weeks. I was limited to jello,pudding and soup and that grew old quickly.

My second issue was a pain in my chest shortly after surgery that bothered me for a couple of weeks and made it hard to breath. After a few days on mediciation for pneumonia the dr sent me to the ER and test showed I had a blod clot. I was kept in the hospital and given blood thinner and released when all test came back normal.

How a month out of surgery I am still having issues with swallow some foods. NOt sure how long this will continue.

In addition I have began having pain and soreness in my neck and shoulders. I have not had any therapy yet hopefully that will help with the soreness and pain.

My next issue to deal with is my company has changed work comps coverage and is forcing me into their network. Not sure how this will affect things since I have been with my doctor and surgeons now since april of 2010. I think I should be allowed to stay with the doctors who been treating me instead of being forced to a doctor who has no clue of my treatments.

[gowen64]

Update. I had my fusion surgery on 6-11. I am suprised from some of the complications that I have experienced. The first was the inability to swallow at all for the first couple of weeks. I was limited to jello,pudding and soup and that grew old quickly.

My second issue was a pain in my chest shortly after surgery that bothered me for a couple of weeks and made it hard to breath. After a few days on mediciation for pneumonia the dr sent me to the ER and test showed I had a blod clot. I was kept in the hospital and given blood thinner and released when all test came back normal.

How a month out of surgery I am still having issues with swallow some foods. NOt sure how long this will continue.

In addition I have began having pain and soreness in my neck and shoulders. I have not had any therapy yet hopefully that will help with the soreness and pain.

My next issue to deal with is my company has changed work comps coverage and is forcing me into their network. Not sure how this will affect things since I have been with my doctor and surgeons now since april of 2010. I think I should be allowed to stay with the doctors who been treating me instead of being forced to a doctor who has no clue of my treatments.

[1171]

I'm confused.
a claim is not transferred from one carrier to another when an employer choses to buy coverage later on from another carrier; the claim stays with whichever carrier got the premium.
maybe you are confusing third party administration of a self-insured employer with insurance coverage?

in any event you might want to review the rules for use of networks to make sure the procedures and process are being followed:
http://www.tdi.state.tx.us/wc/wcnet/index.html

[Thalia]

ok, I'm REALLY new at this.
I'm in Cali, next month will be a year since I had the same Rotator cuff surgery. I also had a separate accident with my knee. Anyway Being a person not experienced with surgerys', I think the shoulder is awful to try to come back from. I have limited range and now about 8 monthes out,I can at least drive again. My doctor released me to work no restrictions at 5 months. My case has not even begun yet. The case with my knee might be about resolved, ( i got court papers saying approved for award..but don't know how that translates)
I'm 57 but after injuries like this, my whole existance has dramatically changed.

[gowen64]

My employer changed to a network plan last october and is forcing all old injuries into the network. Which only has two options for coverage and that is Carenow and Concentra are the only facilities in the plan which are all company oriented providers.

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My employer changed to a network plan last october and is forcing all old injuries into the network. Which only has two options for coverage and that is Carenow and Concentra are the only facilities in the plan which are all company oriented providers.

[gowen64]

Well just update my situation.

I was undergoing therapy for my neck and shoulder. When the wc insurance pulled me into the network and away from my treating doctor and surgeons.

Since then the process has been very slow even slower than it was before.

The sent me to a new treating doctor. He said it was going to be hard to get a surgeon to see me after already being treated by one. But that is what the insurance company wanted. So he sent me to a ortho for my shoulder and he refused to see me and said I would need to go back to the original surgeon for treatment.

They are also trying to find a spine surgeon to see me but havent as of today and its been almost a month.

I look at this a being a piss poor move by them. I had been with my doctors for almost a year and half and they stop my treatment to start all over and have not made any progress.

Now it looks like they will drag this out for awhile before getting me back to my surgeons. Since no one else in their network will treat me.

[gowen64]

Well update to my story. I was pulled into the insurance network and away from my treating doctors.

The new treating doctor made a effort to keep me with my surgeons but the insurance company wouldnt go for it and kept searching a doctor in their network that would treat me.

They tried two shoulder surgeons before getting one to say he thought I was done and had reached MMI, Which is odd because when I first saw him he told them I didnt want to do anymore treatment so I was done, Which was not the case I told him I would do what ever it took to get my shoulder better, I then called his office and they said it was a mis communication and that they would submit a request to the insurance adjuster,

The next response I got from anyone was that the doctor had replied back to them and said he didnt think that any treatment would be needed at this point and once again I was at mmi in his opinion, I was amazed it didnt matter what I said about treatment he was not going to do it.

I was also sent to see a spinal surgeon and he wanted a MRI and xrays done to see if their was still something going on that could be taken care of,

Shortly after this visit I received a letter from the state saying a dedicated doctor appt had been scheduled to determine MMI and any impairment rating.

I went to the appt and the doctor said I was not at MMI and that I needed the mri on my neck and shoulder to determine if anything is still wrong that can be fixed surgically or with therapy.

My mri for the neck was then approved and was completed within two days, I am still waiting on the shoulder surgeon to request the mri for my shoulder and its been almost 2 weeks.

[BooBoosNeck]

(05-26-2011 10:55 PM)bodybuilder1958 Wrote:  Official Disability Guidebook.

Is that book state specific? I am in NM