What an IDIOT!!!

[Bummer Knees]

I am not one to call a person names, but the adjuster & case manager for the insurance company deserve it!

I had a total knee replacement 1 yr ago today, and tomorrow is the 1 year post surgery appointment with the surgeon.

History:
I was injured 2005 and due to denials & delays the replacement happened 36 months after the injury by court order of the wc judge for medical treatment including a total knee replacement.

At the 6 month scheduled post surgery appointment the insurance company denied medical treatment, so I went home without seeing the doctor.

Tomorrow is the 1 yr post surgery appointment and when I called the doctor's office to make sure the appointment was going to happen I was told the insurance company denied payment of the appointment. The reason given was the appointment is not for the original injury. ( I have a copy of the medical records and the doctor has documented the month I am to return to his office for the 1 yr appointment)

The billing clerk said she would try and contact the adjuster
again. I gave her my phone number and told her I would contact my attorney.

I plan on going to the appointment in the morning unless told otherwise.

Bummer Knees

[jayne]

Ok I am not up on your laws but I was given an extra award because of crap like that.....I cant even remember what it was called maybe tomorrow I will be able to think again

[fritos]

Dammm, bummer sorry to hear what happened to u.I will pray for U

[kate]

Is it the same case manager and adjuster as when you had the surgery? If not sometimes the previous adjuster doesn't keep good records and the new one doesn't have all the facts. If it's the same one then they apparently didn't pay attention to there own records. In either case, if you have an attorney they should be on top of this.

I hope all turns out well. Keep us posted.

[Bummer Knees]

Kate
I do believe the case manager & adjuster are the same and they should know me well as many times and we have been to court.

I did go to the appointment this morning and did see the doctor.

It was late yesterday evening when I received the phone call from the medical center with the news the appointment had been authorized by the insurance company.

The billing clerk had to go thru 3 different levels to get approval for this appointment.

When the medical billing clerk told me this was being denied I threw an Irish tantrum.
I told the clerk the insurance company dose not want to do this, treatment of this knee is under a court order and this is the 2nd time treatment is being denied and
I will call my attorney when I get off the phone.

I will be sending the clerk a thank you card for her help yesterday as she went the extra mile and made the phone calls in seeking authorization.

On the knee I am at MMI and do have permanent restrictions of limited, kneeling, bending, & squatting, limited lifting over 25 lbs. and no lifting over 50 lbs.

The work restrictions will end my job of 13 yrs as the employer refuses to accommodate any restrictions.

[fairycatz]

Sorry about losing your position/career of 13 years. That really bites, and just adds to your frustration. Whatever small amount of compensation you might get from WC will not be enough.

Glad that you were finally able to get in to the Doctor. How ridiculous that whole situation is. If your knee fails due to improper care, the IC will just have to pay for another one. I suppose they don't really care, and just do whatever saves them money. Of course, they REALLY don't care about what aggravation and stress they put YOU through!!

I hope that getting this info from the Doctor has brought you some ease-I know how much getting answers has meant to me.

[Bummer Knees]

Thanks fairycatz

I worked as an Early Childhood Teacher and if I were to work in the classroom I would be placing the students at risk. If one of the children were hurt or to become ill my disability may prevent me from providing the needed assistance.

So I do understand the reason for termination.

The medical treatment for the knee is by court order and with the insurance company not authorizing treatment, it will not look good for the insurance company if we were to go back to court.

[nwpapa]

Bummer Knees Wrote:I am not one to call a person names, but the adjuster & case manager for the insurance company deserve it!

I had a total knee replacement 1 yr ago today, and tomorrow is the 1 year post surgery appointment with the surgeon.

History:
I was injured 2005 and due to denials & delays the replacement happened 36 months after the injury by court order of the wc judge for medical treatment including a total knee replacement.

At the 6 month scheduled post surgery appointment the insurance company denied medical treatment, so I went home without seeing the doctor.

Tomorrow is the 1 yr post surgery appointment and when I called the doctor's office to make sure the appointment was going to happen I was told the insurance company denied payment of the appointment. The reason given was the appointment is not for the original injury. ( I have a copy of the medical records and the doctor has documented the month I am to return to his office for the 1 yr appointment)

The billing clerk said she would try and contact the adjuster
again. I gave her my phone number and told her I would contact my attorney.

I plan on going to the appointment in the morning unless told otherwise.

Bummer Knees

I can relate. I hurt my back and was told I had a pulled muscle. I went through PT and was released to work. About 3 months later I felt the pain again and was told the same as before. 2 years into it the WC Dr sent me in for further testing which revealed I had 2 herniated discs and would need surgery. Heres the kicker, WC tried to say that I had just hurt my back in the last 2 months because they had no record of my original claim. In short they had 2 claims one for the original onset of my back problems (which they closed) and a new claim they opened. They never tied the 2 together until I corrected them. It appears they look at a computer screen which only shows you as a claim #. If they used our names they would better be able to put 2 and 2 together (hopefully they would be able to make 4 out of it)lol... But, if they used our names then we would be people to them and that may cause, God forbid, them to look at us a humans in need. Some workers are better than others but, enevitavbly, we have to keep on our toes to be sure they are doing there best for us.