getting runaround from insurance on future med

[mtodd4au]

I had a back injury 12 years ago and settled everything except future medical. I've lived with the pain, but twice in the 12 years, I've felt I needed to see a doctor. The first time, it took them 8 months to agree to let me see a doctor. This last time, I requested to see a doctor back in Sept 2009. They told me they have a new computer system and couldn't find my claim. After a few weeks, I faxed them my settlement agreement. They told me it would have to go through their legal dept. Two weeks later, they couldn't find my settlement agreement and asked if I could fax it again. I did. After a few more weeks, they said I needed to talk to another adjuster. She needed the paperwork again. Long story short, I got the run-around until about mid-February...at which I decided to just go to the doctor on my own. I was referred to a specialist that looked at me several times and tried various methods of treatment.

Now, my workers comp insurance is saying they won't pay any of the claims because I didn't get their approval. I am from Alabama and I know laws are probably different depending on state, but should I be held responsible for these bills? I would think any reasonable person suffering the pain of 3 disk herniations would eventually seek relief if they didn't feel they were getting anywhere with the insurance company after 5 months. I'm sure I could win this battle in court, but I know an attorney would cost me as much as the medical expenses. Anyone have any advice, please!

[tpm]

mtodd4au Wrote:I had a back injury 12 years ago and settled everything except future medical. I've lived with the pain, but twice in the 12 years, I've felt I needed to see a doctor. The first time, it took them 8 months to agree to let me see a doctor. This last time, I requested to see a doctor back in Sept 2009. They told me they have a new computer system and couldn't find my claim. After a few weeks, I faxed them my settlement agreement. They told me it would have to go through their legal dept. Two weeks later, they couldn't find my settlement agreement and asked if I could fax it again. I did. After a few more weeks, they said I needed to talk to another adjuster. She needed the paperwork again. Long story short, I got the run-around until about mid-February...at which I decided to just go to the doctor on my own. I was referred to a specialist that looked at me several times and tried various methods of treatment.

Now, my workers comp insurance is saying they won't pay any of the claims because I didn't get their approval. I am from Alabama and I know laws are probably different depending on state, but should I be held responsible for these bills? I would think any reasonable person suffering the pain of 3 disk herniations would eventually seek relief if they didn't feel they were getting anywhere with the insurance company after 5 months. I'm sure I could win this battle in court, but I know an attorney would cost me as much as the medical expenses. Anyone have any advice, please!

I think at this point an attorney will be worth the 15 or so percent that he or she may charge
Best of luck to you

[Bad Boy Bad Boy]

I would call your State Ombudsman


http://dir.alabama.gov/wc/ombudsman.aspx