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very upset!

tammycttammyc Posts: 894
edited 06/11/2012 - 8:40 AM in Neck Pain: Cervical
~X( I called my therapist this morning because i've been having some trouble with burning sensations going from my lower back into my legs. Its causing me to wake up multiple times a night and i thought that he may have some suggestions as to what i could do to make it better when it occurs.His secretary told me that he was on vacation so she couldn't get the answer for me,but then she told me that she got the report from my insurance co. today and it said that there denying my physio because of the assessment that i had done with the therapist that i had seen. My doctor won't fill out the papers that they had sent for her to fill out and now i have absolutely no idea what to do.I feel like i've been robbed. I was doing so well after my operation,i felt like i finally started to get my life back. This stupid accident that someone else caused has left me with multiple problems that now i can't even work on because the insurance co. seems to have total control over and my doctor is blocking my progress at every turn.I just want to sit and cry.How can i progress if no one will help me??? My therapist told me that he would do everything that he could for me but how can he if there not allowing his program.Is there no way that i can get therapy without the insurance co. just because it was an accident do they absolutely have to be involved?Someone help me!! ~X( :''( :''( :''( ~X(


  • Gosh Tammy,

    I am sorry. It doesn't seem right or legal. I hope the docotor can be forced to do the paperwork. Is there an office manager that you can call and discuss this with? If not it may be worth hiring an attorney (even if it costs a couple hundred) just to get the letter/forms delivered officially).

    I know my doctor didn't get my paperwork in right away but it wasn't really him it was his nurse. The short term disabilty paper work was about getting some form of monthly paycheck and she drug her feet- I remember being upset and calling about everyday. There is not much else one can do.


  • i called her nurse back and asked why she refused to do the paperwork and she said that she didn't give a reason just handed her the forms and said that she wouldn't fill them out. This is just forms for me to continue to get monies for things that i'm having trouble doing around the house since the accident.Its not even a long term benefit.
  • Correct me if I am wrong, but it looks as if you have two issues going on here.
    1--they denied you further PT based on an assessment completed by your physio
    2--your medical doctor won't fill out some type of form to allow you to continue receiving help with household duties

    The first about the PT. You need to get a copy of the assessment that was sent in, along with a copy of the denial. Study those documents until you understand what they say. If you can take the emotion out of it, possibly you can find a way to argue the need for continued therapy. An appeal will need to be done, and the way to start it is by having your physician write a letter to the insurance company stating the need for continued physical therapy. She needs to be specific with what areas she wants targeted and why you will benefit from continued therapy. The physical therapist should have put something in the assessment about the progress you have made and his anticipation for future progress. He should have written something in that report to show them that you need this. If he didn't, then he dropped the ball and that would be why they are denying it.

    The 2nd issue--If the doctor doesn't want to fill out the paperwork, it is possible that she doesn't think you need these services. Send a written letter over asking why she won't fill the paperwork out, and what her suggestions are for you.

    I do hope you have an attorney involved at this point. Your case is so complicated with the car accident causing whiplash so shortly after your fusion surgery. i don't advocate hiring an attorney for simple cases, but this may be one where you want your rights protected. An attorney can get results where we can't. An attorney can get you an appointment to see another doctor who will stand behind you if this one is not working out for you.

    Bottom line is you want to get well, and if there are so many roadblocks stopping your progress, things have to change. You have to take this into your own hands and get some results. Get copies of those reports and go from there.

    Tammy, I am sorry you continue struggling with all of this. It just doesn't seem fair, does it?
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • I don't know why my doctor wouldn't fill out the forms for the insurance co. as she's never given a reason.As for the therapy,she sent me for therapy on my back and told me when she sent me to get as much of it as i possibly could because she refuses to send me to a surgeon no matter how bad my back gets.
    I haven't seen my physical therapists report that was sent to the insurance co. this time because my therapy was suspended and i was not going at the time it was sent out but i have read all the notes he sent in up to that point and his interpretation of what has happened to me was write on the money every time.I really can't wait to get the assessment next week and read what was said.
    I do have a lawyer and have met with him but he doesn't know yet about what has happened this week.i'm just waiting for the assessment to come so that i have it with me when i see him again.I've only met with him once before and he told me to continue working with the insurance agency until we could take it no further,maybe that has happened now i'm not sure but i guess i'll find out soon.
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