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Is workers comp responsible for er neck surgery
#1
My case is actually quite complex.  I have multiple injuries that my recent qme states are 100 percent work related.  From the beginning they have tried to deny treating my neck until the very end where I now have permanent nerve damage and nerve compression in several areas of my neck.  So in October. Of. Last year. I woke up and could not move I managed the make it to my comp pcp where they put me on prednisone dose pack and said I needed an urgent MRI repeat.  A week later after hearing nothing again I woke up and it was so severe I had to go by ambulance and er surgeon performed. Er cervical disce tony with fusion and plates in three levels.  Surgeon was we'll aware it. Is a work injury with a cuTrent claim yet I just found out instead of getting a. Pre auth from Insur co they billed it all  to my medi cal Insur   Is that legal and what shou I do   About to  to s
 
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#2
When you wrote they have denied treating your neck do you mean that body part was denied or treatment was denied by UR like spinal fusion? If the treatment was denied often times private insurance will provide treatment. This is something I would check with your private insurance carrier.

If your neck is an accepted injury I recommend contacting the hospital billing office and provide them with your work comp info and tell them they billed the wrong insurance. I recommend when going to the emergency room for a work related injury only give them your work comp claim info or they may attempt to bill your private insurance. However if this surgery was denied by work comp UR system previously, I am not sure if your private insurance will be stuck with the bill. You can contact your private insurance about this as well. They may attempt to place a lien on your case against your work comp carrier.(unknown)

Did you contact your work comp doctor before going to the ER? Usually they will tell you to go to the ER, and this way it is all documented. Did your work comp surgeon perform the surgery or ER doctor?

Unless your PTP wrote expedited review it can take 5- 14 days to get something approved if UR needed more information, and why you may not have heard anything in the 7 day period. Generally it takes 5 business days for UR to respond to requests, but there is a expedited review process.

Do you have an attorney?

I know of other WC patients who got spinal surgery via emergency room.

How are you doing since your neck fusion...are your symptoms better or worse?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#3
Your health insurer has legal rights to seek reimbursement from the comp carrier. They can file a Lien. Insurers do this with each other all the time; coverages and liability is often complex especially in situations with critical time frames.
It's nothing you have to be involved in.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#4
(07-28-2016, 07:23 PM)Sassy616 Wrote: My case is actually quite complex.  I have multiple injuries that my recent qme states are 100 percent work related.  From the beginning they have tried to deny treating my neck until the very end where I now have permanent nerve damage and nerve compression in several areas of my neck.  So in October. Of. Last year. I woke up and could not move I managed the make it to my comp pcp where they put me on prednisone dose pack and said I needed an urgent MRI repeat.  A week later after hearing nothing again I woke up and it was so severe I had to go by ambulance and er surgeon performed. Er cervical disce tony with fusion and plates in three levels.  Surgeon was we'll aware it. Is a work injury with a cuTrent claim yet I just found out instead of getting a. Pre auth from Insur co they billed it all  to my medi cal Insur   Is that legal and what shou I do   About to  to s


If its work related it's workers comp, end of story
 Best of luck

.
Sad  CDC Guideline 2016 Prescribing Opioids for Chronic Pain will be the death of me.
[url=http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm]http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm[/url]
 
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