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Compensation Question

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:31 AM in Health Insurance Issues
Im facing surgery after 5 yrs dealing with chronic pain in the lower back and neck caused by a bad accident. My doctor wants to do replacement and fusion, ive looked up the cost of this type of surgery and nearly stopped breathing really, not factoring in recovery cost and such and that was just for my lower back.

I have had to fight tooth and nail to this date for every med and treatment as it is, and now facing the high cost of one and two surgeries and the payer comp, they do have a right to decline from my understanding, and I have a right to appeal and have a hearing, the cards are stacked against me also seeing im close to my retirement, but im young and could work longer if I recover well after both surgeries, but not sure at this job.

My main question is, has anyone ever dealt with compensation at work (insurance) for major surgery like lower back and neck ? and what kind of luck have you had or not had ?

Its taken me years to get this far with battles for treatment, social security and such, im just wondering what type of fight if any I could face now.

Thanks in advanced for any responses.


  • checking with Medicare in order to see what they would cover and how that would work with them if w/c refuses to pay. Good luck.
  • Hi Slayers,

    Most doctors would have to write the prevailing factor for your need for surgery is the accident of the date you are speaking. You may want to get copies of your medical records and see if this exist. Even thought work comp may have been covering the treatments to this point, you still have a right to those records. Now if you settled that claim and it is closed they may not be responsible any longer. I'm not a attorney but those are my experience in dealing with the situation. It is a major reason why i won't settle without future medical. Should i try to go into my private insurance they will say it is a work injury. Not sure what state you live in, but in my state if work comp is refusing to pay the bill the insurance company has to pay. So in fact you always will have a pre-existing condition when you change insurance and riders don't apply when it is related to the spine. Good luck and let is know how it works out.
  • I live in NY and im not really sure if medicare will cover any of the surgery, from what im being told by one person, it wont. My case has not even been closed out as of yet, its been an ongoing cluster, and I think this is going to really make matters worse but I could be wrong 2.

    Comp pretty much shoots down any type of treatment to date, they dont like paying for my meds still even and make me jump through hoops for those still.

    They have 30 days to either approve or decline the surgery, so ill find out sometime soon, thank you for the response, ill keep yas posted as well.
  • www.injuredworkersforum-workerscompensation.com lots of information there for you
  • I'm curious why it has taken 5 years to finally decide to do surgery?

    I understand being conservative in treatment. I went that route. It almost worked. Due to an accident it all got thrown out the window. Since it was an MVA that caused this current problem. I have 3 years in this state to settle or they get off the hook for free. So it kinda sux in that you need to get surgery done within 3 years or sue for "future medical" like Tam is talking about. The lawyer I talked to says he always tries to add future medical. In most cases the ones paying will refuse to settle with that included. Can't say as I blame them. You have them on the hook indefinitely.

    I will not let this go past 3 years. It will be resolved this year before we hit the 3 year mark. It's no fun deciding on surgery due to a timer expiring...
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