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WC Aquatherapy is hazardous / Now more problems

reptilesrreptiles Posts: 15
edited 06/11/2012 - 8:25 AM in Health Insurance Issues
Hi,

Just throwing this out there for comments. I'm Workers Comp --other benefits expired.

Been doing aquatherapy and PT for 2 years (WC pays for that.) Here are the latest two therapy-related issues:

I got an inguinal hernia while at therapy. They sent me to my rehabilitation medicine doctor --he said, its no big deal, just see a surgeon and get it fixed.

Other injury was a mild scrape on my arm (while climbing out of the pool -- I'm not too graceful, as my left side is quite weak) which developed quickly into an infection requiring treatment in the local ER. That bill is $3,500 for IV antibiotics, etc.

The WC insurance company won't authorize a general surgeon to fix my hernia. They won't pay my hospital bill.

Their position is that these injuries are not related to my original accident. My position is that they are indeed because if not for the work injury, I wouldn't be doing PT and aquatherapy.

I do have a lawyer, but we all know how timely they get back to us, right? lol

Appreciate any comments or related experiences.

Regards,

R.
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Comments

  • That's not right because you probably got the hernia struggling to do therapy. In Canada hernia repair is now considered elective surgery and it isn't covered even under work insurance. Only if it's causing some kind of physical interuption of other organs functioned it is covered. One thing that it is covered if it upsets you to the point where it interferes with your life and causes you psychological stress but you'll need to get a Dr. to write that letter after his assessment. I think WC should cover it and hope you're lawyer will help you get that ok for surgery. Good luck with that. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • ..and their surgeon was good.We got a specailist that only worked on that.I think he was a urologist..it's been quite a few years and I'm falling asleep,but you will need that checked out.

    Most inguinal hernias in adults result from strain on the abdominal muscles, which have been weakened by age or by congenital factors. The types of activity associated with the appearance of an inguinal hernia include:

    Lifting heavy objects
    Sudden twists, pulls or muscle strains
    Marked gains in weight, causing an increase in pressure on the abdominal wall
    Chronic constipation, which places a strain on the abdomen while on the toilet
    Repeated attacks of coughing
    A hernia is called reducible if the protruding sac of tissue can be pushed back into place inside the abdomen. If the hernia cannot be pushed back, it is called irreducible, incarcerated or imprisoned. The symptoms of inguinal hernias vary. Sometimes the onset is gradual, with no symptoms other than the development of a bulge. Other times, the hernia will occur suddenly with a feeling that something has "given way." This feeling can be accompanied by pain or discomfort. Signs and symptoms of inguinal hernias can include:
    Visible bulges in the scrotum, groin or abdominal wall
    A feeling of weakness or pressure in the groin
    A burning feeling at the bulge
    A gurgling feeling
    In some cases, an irreducible hernia gets so pinched that the blood supply is cut off and the tissue swells. Rapidly worsening pain or a tender lump is a signal that the hernia has strangulated. When strangulation occurs, the tissue can die quickly and become infected. Within hours, this condition can lead to a life-threatening medical emergency that requires immediate medical attention.
    Preparing for the Operation

    Unless the hernia is strangulated, hernia repair typically is an elective operation. Only you can decide whether you ought to proceed with the repair. However, you must realize that (1) the hernia is not going to heal by itself, and (2) pain may increase in the area of the hernia, and it will usually increase in size over time.

    Prior to admission to the hospital, you may be given standard tests to measure your complete blood count and electrolyte levels, as well as a urinalysis. Your surgeon may require additional studies depending on your condition and age. Prior to the operation, you will dress in a surgical cap and gown, receive a sedative by injection, and have a needle placed in the back of your hand or in your forearm for connection to an intravenous line in the operating room. In addition, the area where your incision will be made will be shaved. The procedure generally takes less than two hours. You may be given a local, spinal or general anesthetic depending on your surgeon's preference, your age, your state of health, and the procedure's degree of difficulty.

    Outpatient Surgery

    Unless there is cause for concern, hernia repair can be done on an outpatient basis. On the day of your operation, you should wear loose-fitting, simple clothing to the hospital, such as a sweat suit and slip-on shoes. That way, upon discharge, you will be able to get dressed easily without too much strain or discomfort. Generally, you should not eat on the morning of your operation. You should have a friend or relative drive you home after the operation and, ideally, someone should stay with you the first night, particularly if your bedroom is on the second floor of your house because stairs will be difficult for you to climb.

  • I did aquatherapy last month and since I started my neck has been killing me (I was in therapy for my back) had an MRI and I now have a buldging disc in my neck.Well I never had neck issues before ,so far wc payed for the MRI so i'll have to see ,but I feel that anything that happens once you enter the front door to the therapy place is on wc tab at least it should be like you said you wouldn't be there if they didn't want you there.Good luck
  • This is just a idea. If you are having issues getting your attorney to return you phone calls maybe getting the email addy may help. For myself it is much easier to communicate that way with her. Also there is no confusion in what I'm requesting and can be forward on to her paralegal if need be. I just recently got her email addy and the communication is so much smoother and there is no third party involved in the communications. Another thought is using a fax letter to the office to communicate with them. Sorry to hear about your troubles with the therapy. I do hope you get the help you need to correct the issues.
  • I'm sorry you're having neck problems now. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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