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Insurance Nurse coming to my appointment

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:18 AM in Neck Pain: Cervical
Hi, I will be going for my 3 month post op on Monday, with my NS. I just got a phone call today that I will have a nurse from the insurance company there who will be talking with my NS. I told my lawyer no way no how is she to be in the room with me. If I must, she can talk to the NS after I am done. I want to be in the room yet if I can, to see what she asks. Any advise on what I should and shouldn't do? I just want to make sure this goes over smoothly...


  • Is this for WC? Pretty typical. The nurse should meet with the DR after you appt. You probably already filled out a HIPA form so she can legally get your medical information.
  • She injured herself in a fall at work and broke her pelvis. This was almost 4 years ago and she is still having constant pain. She is currently moving towards a trial with the SCS implant. A nurse hired by the insurance company goes with her to almost EVERY doctor's appointment. Like Crash said, I think this is pretty normal for workman's comp.
  • Our these nurses helpful for me? Or are they just there to get the doctor moving on getting you back to work? I am hoping it is a blessing in disguise. For I am sure I will need my shoulder checked out yet. Maybe it will get the ball moving in the right direction.
  • You can change your HIPAA releases at any time-I just did one b/c of personal reasons.

    I have been dealing with a w/c case for quite some years, and have never had a nurse come to any of the appts with me (not one that worked for the wc insurance any way)

    I hope that he/she is there to help you like you said-blessings in disguise are quite welcome!
  • Justme - Yes, my friend's nurse (who did work for the insurance company) does seem to have my friend's interests at heart. As I mentioned earlier, her injury was in Dec 2003, and since then she has had 3 surgeries, injections, nerve blocks, you name iT! The insurance company has never denied anything. I think she is one of the lucky ones, however. Has the insurance company been treating you well? Of course the primary motiviation is to get you better, and get the case closed. Let us know how it goes.
  • Hey Justme,

    Well i can tell you all about the nurses that go to the doctor with you as i have a nurse case manager who attends every appointment with me. Until the most recent surgeon on the advise of my attorney i never let her in the examining room with me. After i would see the doctor then we would let her in and discuss the options that i had already agreed to. Then one day that stopped and the surgeon was no longer talking to me but rather talking to the nurse as though i had a sieve brain and wouldn't understand what was happening. I can even describe the levels of frustration that it caused. About the one good thing i have found is they can get test approved much faster but as far as my case manager and understanding my condition she knows less than i do. I had informed work comp about the lack of communication between myself and the surgeon last summer(my last conversation i will have with them) and i was told they are not paying for me to speak with the surgeon and whatever information i need to get from my case manager. From the get go I had issues with someone following me to the doctor as i have been going by myself for along time. They are there to try and get the doctor to release you and get you back to work. Which is what we all went as soon as possible but able to do the job we are employed to do. They work for the insurance company and not you. My case manager is rather nice but she has told on me and caused major issues between me and my company. It was over something i said that was taken the wrong way. Within a hour i was getting a call from my employer about it. Do not offer any information to this person only your medical information and the what is wrong with you medically. Do not answers questions about what you do all day or anything that is not about your medical condition offer up all the things you cannot do. I have problems functioning do daily living task for example one of the questions was do i carry a laundry basket. I had to think about it. I don't use laundry baskets anymore cause they are awkward for me. I didn't realize that was the reason i stopped so the questions should have been can i do laundry. They will be checking about how you cook. Well i can still cook just not what we used to do or eat. For myself the basic living task can whip me out for days. I do pay for a house cleaner and yard maintenance and i make sure they understand that as well. For your appointment i would arrive 15 minutes early. Maybe i will catch you in chat and can explain some more things to you as well if not good luck on monday.
  • My insurance company nurse ..ENSURED. that my workmens comp company STOPPED paying.period.everything i said to her in confidence,was relayed directly to the cheapazz ins.company.now i have NONE .keep th nurse out,it will serve you better in the long run,
    this is just my experience,you may get an honest ins.nurse.all offence intended.
    William Garza
    Spine-Health Mod

    Welcome to Spine-Health

  • I don't understand. Can you PM me the details?


  • Hey Just me, My experience with insurance nurses if they are w/c was not good. She is not on your side .You would be wise to watch closely what you do and say around her. They can come off as very nice and I am sure they vary in loyalty to their employer and such, but ultimately, they work for the ins co and are there to represent them and find info about your case maybe even to show up later as damaging testimony at a hearing. I would be stingy with my trust if I were you.
  • Just here is a link that may help you on somethings that may becoming your way.
    http://www.corporatecrimefighters.com/g … an_IME.pdf
  • Hipaa is law that will protects The information on Health and Provides information on Health. As the name HIPPA represents Health Information Portability Accountability Act. This help the medical patients in providing every latest information on Health and various treatments. Hipaa gives information in quickest way to the people through the internet.
  • There are definitely HIPPA regulations involved with a nurse case manager going into your appointment with you. My (former) Nurse Case Manager led me to believe I was signing a release for her just like the one I had all ready signed for the claims adjuster. When I later asked her for a copy she told me I had never signed one. I knew that was a lie. So, I sent a certified letter to the insurance company stating I was revoking all prior authorizations and I signed a new one (HIPPA complaint) that I got from the Workers Comp website. The new release does not allow anyone to come into my appointments with me OR have phone conversations between my health care providers and my employer or their insurance company. I don't believe they send a Nurse Case Manager to help the patient, that person is there to help the insurance company. It's bad enough I feel awful due to my injuries, I sure don't need that crap too!
  • My W/C Insurance just mentioned to me that they wanted one of their Nurses to go with me to my next appointment. I thought it was odd they would ask now since they have never before (since November 2010) but now I am thinking it is time to call the Lawyer to see what they suggest before the appointment. Thanks for sharing your experiences and input.
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