I was injured at work in '06 and seen the company doctor. They couldn't do anything for me, so I went and seen my own orthopaedic doctor in Morgantown, WV. He was unsure of what he thought, so he referred me out for a second opinion in Pittsburgh, PA. That doctor took out my pisiform bone in '07. That surgery caused problems with my ulnar nerve, therefore I went back to my doctor in WV and he decided to do surgery on the 28th of this month. However, workers comp case manager called me today and said no, I wont be having surgery ..they aren't paying for it. They said this is enough, they want a third opinion? Can they do this? Can they have my surgery cancelled?
No they can't cancell it, but they can refuse to pay and then most likely the doctor will cancel it
Sorry to say lil>>>rholmes is right. I had a back surgery cancelled the night before I was having it.
CAP
Cancelled my son's surgery twice.
Sorry to Say, but the Above are Correct. If the i/c want a Third opinion, and they are Ultimately the Ones Paying for the Surgery, that's their Right. The way they do things by Refusing to Pay at the Last Moment is nothing short of Harassment, and Designed to just Add more Stress to Our Lives!! Hang in there, and I Hope All Turns out Well!!
thanks for all of the replies. I've been having so much trouble with my hand since 2006 ..and just when they tell me they can do something to help me, workers comp doesn't want it done. It makes no sense to me, because two doctors already agreed the surgery was needed. Does anyone think they're just doing this to me for some odd reason? I mean, I could be taken care of and off their back.. but yet, now they don't want to pay. It upsets me a lot, because I just graduated last year and had to take a year off before starting college due to this. Now it's going to be longer..
I guess you have the answer to your question...I had both of my surgeries postponed 1-3 days before the surgery, in fact my 1st surgery, my lawyer called the day before and they were trying to cancell it and all day we did not know 1 way or the other. My surgery was at 10 AM and I was finally told at 7AM that it had been cancelled. I am sorry this is happening to you.
conner,
WC does not care what they do to your life plans OR your pain . You having to wait & wait & wait...is not their concern. Bottom line.....they still have the surgery money in their bank, collecting interest for them, so delaying your surgery is to their benefit, but sadly not yours. This is a tactic they use in hopes you'll just disappear!
Go to their 3rd doctor if that's what it takes.
Prayers for you...Lilly
It is often helpful to pin the insurer down about the reason for denial (causation etc.) because it limits their ability to change their story later.
I personally went through three or four different objections to care over a two year period. First it was "injury not related to work." After 6 months on the eve of trial they agreed injury was related, but "treatment not reasonable and necessary". Again after 6 months they agreed treatment was resonable and necessary, but objected to Drs. fee. for 6 more months
etc. You might find it helpful to address their objections all at once to avoid further delays. Before you go to the third Dr., you may want to read my post concerning insurance exams. It is by far the best advice I have seen on handling insurance exams, and I wish I knew it when I was where you are.
Many injuries become permanent in a year or so, and they may find it cheaper to pay a disability rating than to pay for surgery. Very sad but very true. The system has little or nothing to do with your well being.
wow ..i really can't thank everyone enough who replied. I am on 19 and have been dealing with this injury since I was 17. I don't have any idea about their sneaky ways of doing things, I guess it's time I get an attorney, right?