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Good experience with work comp? Anyone?

WendyFWWendyF Posts: 3
edited 10/24/2013 - 8:11 AM in Health Insurance Issues
I am in the midst of a WC nightmare. I need fusion at L3-4-5 and a laminectomy. WC has authorized the laminectomy and fusion at L4-5 but not L3-4. Their guidelines require a slip to be 4mm to qualify for fusion and in March mine was 3.5 mm. My Spondylolisthesis was diagnosed in January, my doc requested treatment in April and it was denied then appealed 3 times. I had to lawyer up in June. I was injured in my preschool classroom 7 years ago and have had a laminectomy and 2 hip bursectomies since. I was not able to begin the school year and will need 3 months after surgery before I can go back to work.

Looking through my very large WC file I realized that WC has always denied surgery and has always made me wait and jump through very high hoops before authorizing anything besides office visits and even those sometimes, like PT and psychiatry. I understand they are all about the bottom line and it's not personal. It is crazy wrong, however, and so demeaning, insulting and FRUSTRATING to be at their mercy.

I want my life back. I am very very close to telling WC to xxxx and use my private insurance. Has anyone here done that? My lawyer doesn't want me to - she says that is precisely why they drag things out. I don't care. I surrender.

Post Edited for Inappropriate Language Liz (moderator)
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Comments

  • There is a good chance your private insurance wont pay since your injury was a WC claim. Keep in mind if you go to a private doctor for treatment, it sometimes relieves workers comp from ever having to do anything else for you again regarding the claim. It sounds to me like your lawyer needs to get aggressive with the WC company to get you the care you need. I'd follow his suggestion of not seeking private care.

    Light a fire under your attorney's rear end!

    Keith
    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Your private insurance will not pay for a WC injury.
  • WendyFWWendyF Posts: 3
    edited 10/30/2013 - 4:09 PM
    Work Comp authorized my surgery yesterday! I'd like to think my call to the superintendent on Friday had something to do with the change in their decision but I'll never know.

    My private insurance would have covered it but only after the work comp case was completely closed. And with the knowledge that fusions put extra stress on the adjacent levels and more surgery may be in my future I want to keep the medical open.
  • RangerRRanger on da rangePosts: 805
    Way to go Wendy, glad it finally got authorized. I would be surprised your private insurance would have covered it too.
    And yes fusions can and do put stress on adjacent joints, I'm living proof of that. Hence my first cervical fusion was in 2007 and at that time I was told I will need more in the future. My future surgery will be in early 2014, next 2-3 levels below and quite possibly 2 levels above the previous fusion.
    Life is good!
    ranger
  • I want those of you who are fighting the good fight, whether your opponent is work comp, SS, or your national system to hang in there and understand that these hoops they make us jump through are designed to weed out the fakers. The bad apples have, once again, made life for the good apples considerably more difficult. Not fair - but as I've always told my children, "fair" is a place with rides and animals!
  • I also am fighting the WC system with my injury from feb 2012, altho since I hired an attorney in May I have had no problems getting anything including surgery, psychiatry, and paying a family member to come and stay with me to take care of me to help me with ADL's and cooking and cleaning and driving me to appointments. So my WC has been very cooperative with me since May. Good luck with your surgery.
    Irene
    Irene
    Orlando Florida
    4 Level ACDF
    October 15th, 2013
  • I have been involved with work comp sense 05 and we are still in the courts. Nightmare, well those you wake up from, this just goes on and on and on. While they have paid for 5 of the 6 surgeries they should have paid for the last. If work comp refuses you treatment then you can use your private health care, but you have to have denial of treatment. Now that doesn't mean if they deny you surgery but offer you physical therapy that they are denying you treatment. The key word is they need to deny the treatment. Always be honest about weather or not it is a work comp injury. Your doctors know what needs to be done, if you are denied treatment. But because you are not getting the treatment you want, that doesn't mean you are being denied treatment. In my case the last surgery work comp had made me MMI(maximum medical improvement), and I had the denial in hand, so the treatments went under my private health care. But typically all doctors know how work comp works in addition to all the different insurance plans.
  • I have been dealing with WC since 2012 and they have denied, paid, denied (after they approved a procedure or test) paid..etc etc. It has been a learning lesson with many tears, 4 overflowing binders and endless notes but I refuse to give up when I know they are responsible for the bill. I have not gotten a lawyer yet but will if things get really out of control. They currently have been calling me back when I have left messages and hopefully will approve a possible 3rd surgery if needed for my lower lumbar disk. My biggest fight has been that they feel that they do not need to pay for anything other than what is related to my back so for example I am allergic to general anesthesia and I get vertigo, keratoconjunctivitis, bladder spasms, nausea, dizziness, vomiting and last time I ended up with Thrush from them giving me Steroid IV's. These complications lead me to staying in the hospital anywhere from 8 to 10 days. I have had my Surgeon, Eye Dr, Neurologists and Anesthesiologist write to WC stating why these should be included on the claim but they say that they are symptoms and not diseases. So we keep fighting the good fight.
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