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Doctor tells insurance its not related



  • I think your Neurologist or Neurosurgeon who made the diagnosis of Horner's syndrome was it? should get in touch with your eye Dr. and say it is indeed caused by the operation. That's the only way WC would be able to cover it. I'm sorry to hear this and hope it can be cleared up. 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
  • Kris what a PIA! I was wondering how your Horners eye is doing. Consider this a small bump in the road. I am sure you will get it handled. Like Charry said have the diagnosing dr get in touch with this other dr and square things up. I am sure it is not that easy- so good luck >:D<

    Prism glasses? Are they very expensive? Do they help?

    I need to follow up since my Horners eye is still driving me crazy.

  • SpineAZSpineAZ WiscPosts: 1,084
    You'll have to "quarterback" the issue by putting together a chain of information so they can see that A resulted in B which caused C.

    Write up a simple statement with dates and outcome to show the path, such as:

    01/05/09 Accident at work doing _________
    01/05/09 Surgery on ____ for ______ by Dr.___
    02/10/09 Symptoms after surgery on __ resulted in ___
    08/09/09 Consultation with Dr. X in regard to ___

    You create a timeline that contains dates, who you saw (specific doctor name), outcome and then show the steps that led to where you are now.

    If you have past records of anything that occurred you'll want to make copies of those to in order to show the progression. Basically proving your case that it's coverable.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Hi;and as already said, you need to have your 2 other doctors send report to w/c stating that your condition was related to your injury.
    W/C is then responsible for the bills.

    Example; around the time i had my w/c injury, my blood pressure went way up.
    Doctor's ordered a ekg, and a stress test for me as a pre-surgical procedure.
    When i went to the heart doctor, the gal behind the desk wanted my insurance info. and i gave her the w/c info. She asked for my BCBS which i would not give her, and i told her this was related to my injury, and was pre-surgical, so w/c can pay it.
    They billed w/c and the bill is getting paid. I've been going to this doctor at the heart clinic now every 4 months, and they always bill w/c, and dont ask for my other ins. info. anymore.

    So definitely get your other 2 doctors informed on this and ask for their help getting w/c to pay the bill.

    Best of luck to ya.
  • Thanks guys for your support. There is really no question that this is a result of the surgery and that no-fault will pay. But for some reason this doctor does not want to say that this is related. My feeling is that he is afraid that he would get called to testify if I file a mal-practice case against the surgeon. I experienced something similar with the neuro-opt. He acknowledges the connection, sees the problem but doesn't want to put anything in writing that might get him involved.

    I have a call in to a friend who works for a company that matches up doctors who will testify with lawyers and patients. Her boss is the one who originally confirmed with an out of state neurologist that this is a real problem. I guess I will need to travel to find a doctor who isn't afraid of the surgeon and hospital that caused this.

    I shouldn't be surprised at this point but it is very upsetting to find that a doctor who I have been going to for 30 years is so unprofessional.
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