08-20-2009, 11:21 AM
HELP!!!! I REALLY DON'T NEED TO TELL MY WHOLE STORY RIGHT NOW , BUT I'M AT THAT CRUTIAL "STARTING TO JERK ME AROUND" POINT IN MY CLAIM PROCESS. I GOT HURT ON OCT 6., 2008. FELL ON CONCRETE BACKWORDS ON TO MY ARM AND HEAD TO THE LEFT . INJURED MY SHOULDER AND NECK. I HAD SHOULDER SURGERY IN JAN 09....BESIDES HEALING PAIN AND PAIN IN MY ARM RELATED TO MY NECK, MY SHOULDER IS DOING BETTER. THE PROBLEM IS MY NECK. I HAVE BEEN DIAGNOSED WITH 2 PROTRUDING DISCS AT C5-6 AND C6-7. AFTER TRYING MONTHS OF PT AND HOME EXCERCISES, TENS UNIT, PAIN MEDS AND ANTI-INFLAMATORIES, I WAS REFERRED TO A SURGEON IN "THEIR" PANEL. HE, AFTER THE INITIAL VISIT, A NEW MRI AND RETURN VISIT, ADVISED ME THAT SURGERY WOULD GIVE ME 90% RELIEF OF PAIN AND FIX MY PROBLEM. THAT MY PROBLEM WAS A BLATENT RESULT OF MY FALL. DURING ALL OF THE TESTS, I HAVE BEEN CONTINUALLY TOLD I HAVE ARTHITIS IN MY NECK. THAT I HAVE DEGENERATIVE DISCS... I HAVE NEVER EVER HAD ISSUES WITH MY NECK TIL I FELL. I WAS TOLD THAT IS VERY COMMON THAT ARTHITIS WILL NOT FLARE UP UNTIL THERE IS AN INJURY. .. BUT ASSURED BY FIRST SURGEON THAT THE DISC ISSUE WAS NOT FROM THE ARTHRITIS . HE , IN WRITING RECOMMENDED SURGERY AND GAVE ME A VERY OPTIMISTIC OUTLOOK ON MY FUTURE WITHOUT PAIN AND REGAIN USE OF MY NECK... I WAS HOPEFUL.
1 MONTH LATER, AFTER PATIENTLY, PAINFULLY WAITING FOR THE APPROVAL, I GOT A CALL, OR I CALLED MY REP, AND WAS TOLD THAT I HAD TO GET A SECOND OPINION. I WAS THEN SET UP WITH A SECOND SURGEON OF "THEIR" CHOICE. HE, AFTER ADMITTING TO NOT READING MY HISTORY OR GIVING A GOOD LOOK AT THE CURRENT MRI AND XRAYS, AND WITH OUT EXAMINING ME EXCEPT FOR SQUEAZING MY FINGERS TOGETHER, TOLD ME AND MADE A REPORT THAT SURGERY WOULD NOT BENEFIT ME. I WAS NOT GIVEN A COPY OF HIS REPORT. AFTER 7 WEEKS AND A PHONE CALL ONCE A WEEK TO MY REP, AND ONE PHONE CALL TO HER SUPERVISOR, I GOT A CALL FROM MY REP STATING THAT THEY WERE DECLINING THE NEEDED SURGERY AND TAKING THE SECOND OPINION, NOT THE FIRST. I NEEDLESS TO SAY , WAS DEVASTATED AT THE THOUGHT OF SPENDING MY LIFE IN THIS LEVEL OF PAIN.
I LEFT OUT THE FACT THAT I HAVE SENT LETTERS, MADE EVERY SINGLE THERAPY, DR APPT, FOLLOWED EVERY RESTRICTION, AND WENT BACK TO FULL TIME WORK 4 WKS AFTER SHOULDER SURGERY AND STILL FUNCTIONING AT A 7-8 PAIN LEVEL EVERY DAY.
MY QUESTION... DO I HAVE THE RIGHT TO A 3RD OPINION AND HAVE W/C PAY FOR IT? I ASKED FOR THAT AND MY REP DECLINED IT. I NEED TO KNOW MY RIGHTS. I HATE TO GET A LAWYER BUT FEEL THAT PERHAPS THEY ARE FORCING ME TO DO THAT...
THIS IS A FUNNY THING TOO.... IN A VOICE MAIL, MY REP SAID THAT THEY WERE DENYING SURGERY BUT THAT IF I "WANTED" THE SURGERY, I COULD HAVE MY HEALTH INS COVER IT !!! OMG... HOW STUPID. NO INS COMPANY IS GOING TO COVER A PREEXISTING INJURY THAT IS DOCUMENTED EVERYWHERE THAT IT IS A "WORK" INJURY!! WHY WOULD SHE SAY SUCH A RIDICULOUS THING ?
I AM BEYOND FRUSTRATED... AND IN TREMENDOUS PAIN EVERY MOMENT... AND WORKING AND TRYING TO KEEP MY LIFE AND RELATIONSHIPS GOING AS USUAL. PAIN CONSUMES AND TAKES OVER IF YOU ARE NOT CAREFUL.... SO PLEASE HELP LET ME KNOW WHAT MY NEXT STEP SHOULD BE ... THANKS TO ALL
1 MONTH LATER, AFTER PATIENTLY, PAINFULLY WAITING FOR THE APPROVAL, I GOT A CALL, OR I CALLED MY REP, AND WAS TOLD THAT I HAD TO GET A SECOND OPINION. I WAS THEN SET UP WITH A SECOND SURGEON OF "THEIR" CHOICE. HE, AFTER ADMITTING TO NOT READING MY HISTORY OR GIVING A GOOD LOOK AT THE CURRENT MRI AND XRAYS, AND WITH OUT EXAMINING ME EXCEPT FOR SQUEAZING MY FINGERS TOGETHER, TOLD ME AND MADE A REPORT THAT SURGERY WOULD NOT BENEFIT ME. I WAS NOT GIVEN A COPY OF HIS REPORT. AFTER 7 WEEKS AND A PHONE CALL ONCE A WEEK TO MY REP, AND ONE PHONE CALL TO HER SUPERVISOR, I GOT A CALL FROM MY REP STATING THAT THEY WERE DECLINING THE NEEDED SURGERY AND TAKING THE SECOND OPINION, NOT THE FIRST. I NEEDLESS TO SAY , WAS DEVASTATED AT THE THOUGHT OF SPENDING MY LIFE IN THIS LEVEL OF PAIN.
I LEFT OUT THE FACT THAT I HAVE SENT LETTERS, MADE EVERY SINGLE THERAPY, DR APPT, FOLLOWED EVERY RESTRICTION, AND WENT BACK TO FULL TIME WORK 4 WKS AFTER SHOULDER SURGERY AND STILL FUNCTIONING AT A 7-8 PAIN LEVEL EVERY DAY.
MY QUESTION... DO I HAVE THE RIGHT TO A 3RD OPINION AND HAVE W/C PAY FOR IT? I ASKED FOR THAT AND MY REP DECLINED IT. I NEED TO KNOW MY RIGHTS. I HATE TO GET A LAWYER BUT FEEL THAT PERHAPS THEY ARE FORCING ME TO DO THAT...
THIS IS A FUNNY THING TOO.... IN A VOICE MAIL, MY REP SAID THAT THEY WERE DENYING SURGERY BUT THAT IF I "WANTED" THE SURGERY, I COULD HAVE MY HEALTH INS COVER IT !!! OMG... HOW STUPID. NO INS COMPANY IS GOING TO COVER A PREEXISTING INJURY THAT IS DOCUMENTED EVERYWHERE THAT IT IS A "WORK" INJURY!! WHY WOULD SHE SAY SUCH A RIDICULOUS THING ?
I AM BEYOND FRUSTRATED... AND IN TREMENDOUS PAIN EVERY MOMENT... AND WORKING AND TRYING TO KEEP MY LIFE AND RELATIONSHIPS GOING AS USUAL. PAIN CONSUMES AND TAKES OVER IF YOU ARE NOT CAREFUL.... SO PLEASE HELP LET ME KNOW WHAT MY NEXT STEP SHOULD BE ... THANKS TO ALL
