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A week ago my IME doctor sent a letter stating that I did not need medication for my injury. Nothing but anti-inflammatory. My primary care doctor yesterday said she would do a state dictation and send it to me today and that i do need every medication that she ordered for my injury. This i need to present to my hearing soon.
Yesterday after my appointment, i went to the pharmacy to get my meds. I had no trouble as they were approved. When i got home my workers comp. advocate called me and said that the new adjuster ( other one went on medical leave) said that i cannot have any more meds approved because of the note from the IME doctor. It was to late as I already got them.
My question is, if the wc insurance refuses to pay for my medication now from my pain clinic, can i use my personal insurance co. to get them, or do i have to pay out of pocket? This is very important that i take them as they are not the type of drugs you can just stop. It includes pain meds, anti-depressants etc. Until I go to my hearing with my note from my primary doctor, what is the best way i can still get these medications paid for?
Sparkey, You are now only touching the Surface of Why I felt it necessary for You to have Counsel. W/C did that to Me about 2 1/2 Years ago, and My Attorney through a Provider got My Scripts Filled on the Fact of Me Winning My Case, (My Attorney has a 95% Win Ratio) and We did Win, and a Bill was sent for $23,000.00 for My Meds. only!! If Your Personal Ins. knows these Meds. are w/c Related they are probably not going to Cover them, and You are going to have to Pay out of Pocket until the Judge gives their Decision, and in My Case it took 2 Years!! If You look back at Your Old Post I did mention that I Hoped they would allow You to keep Your Meds through this Process because I had a Gut Feeling they were going to take them from You as a Pressure Tactic. I Wish I had a Better Answer, and I Hope Your Case goes Quickly!!
yep private insurance will pay untill they find out that its a work related issue.then they can come back on you for the money they paid.i know because my priv ins sent a letter saying that they could come back on me if i lose the wc case.this is true and can happen.i can find the paper and type what it said if you need it.short version this was work related and we will pay NO more bill dealing with your back.........now im stuck with around 8-9000 of bills they didnt pay,thanks to exemployers nurse.
1171 is right, your private insurance should pay if there is a written denial from w/c, but on the other hand, they can come back later and recoup the payments from you, just as others indicated. I think if your medications are so important, try to get the generic through WalMart and pay for them yourself until it is settled with w/c. I used to pay for my depression medication, cost me around $16.00 per month because I am still fighting with w/c for trying to get any type of medical since 2006.
When is your hearing? Hope it goes well. Mine is next month, but as the attorney indicated , this might be just the beginning. As he put it this way, both sides will probably just "test the water" at this time.
Well I will say to anyone now that is just starting out in WC to not be trying to do things on your own as sometimes, many times you will wish you got a lawyer. I have to admit that 9 days before my first hearing I now wish I had one. The ic did not play any games with me till I got my rating which to them was to high. Then the IME exam came and of course money talks and their doctor made mine much much lower than my treating doctor.
I have now got a letter from my treating doctor that did the PIR to read the IME doctor's note and said it was flawed and now have that to present to the judge. Today I got my letter from my treating pm doctor saying how it is very important I stay on these meds and is totally against what the IME doctor states of my condition. So I have two notes to back me up at the hearing plus the other records I have been keeping since day one a year and a half ago.
I am very Nervous of course because I know they are going to pull me down without a lawyer at the hearing. I am preparing myself good to accept that. If anyone is really thinking should I get a lawyer, etc etc. I would say " YES". This is to late for me in this game now, and I can only pray for the best outcome. I do have a 10% that is already awarded to me from the labor board, but still have to go to the hearing because of the difference. This could be in my favor as they made the IC lawyer call this hearing to which they said they never had to do before.
Thank you for all the reply's on the meds. My doctor stated in her note that if the insurance co. does not pay for these, we will find a way to do so. Meaning she is sticking to her treatment for me. Me gettting well is much more important to me than a rateing or money. I just feel I should not have to pay for it when I was hurt doing a job at work ,and pay for it all my working years with my taxes etc. and this is how we get treated.
Sparkey>>>i'm really sorry this is happening to you and wish you all the best. The WC system is very unfair. I would love at some point to educate myself more and be an advocate for the IW. One of the things I find most appalling is tying up treatment for someone who is hurt and all having the knowledge that IME's lie at times and everyone knows this but it is still allowed. you and I would go to jail for Fraud if we lied and a few other charges.
Don't start to loose hope or feel threatened sparkey, go in to that hearing with your head held high and state the facts! You may have realized that you need a lawyer at this point because WC is playing dirty...but you've come this far without anyone's help, and have done ok. You gotta keep the faith that all will work out fine & in your favor.
Know that we are all praying for you to keep the strength! Lilly
Injured worker, & tired of it all! I'm too old for games!!
A careless word may kindle strife, a cruel word may wreck a life, a timely word may level stress, and a loving word may heal and bless!
Well, I just want to add one more thing...this whole w/c system is set up so the injured worker can't win without an attorney. I never had any problem with w/c until a new claims manager started denying all medical two years into my claim, so I was forced to hire a lawyer and I am glad I did.
Unfortunatly just last week my adjuster just went on medical leave. We had always had open communications and never had any trouble with him paying my mileage etc. Sort of had a good relationship with him over the phone, emails. Now I find out I have a new adjuster standing in. He is the one that just told my wc advocate that I can no longer have my meds covered because of the letter from the IME doctor. My adjuster must of approved a few days more before he left, as I got the meds before they were denied. I guess you could say if i did not stop by the pharmacy on the way home like I always do, it would of been hard to fill.
I thank everyone for their blessings with my hearing coming up in a few days. I am scared to death but personally I am looking forward to telling my side to everyone that is there to ask questions etc. I have tremendous pain each day that has severly effected my life and I am proud to be able to go back to work full time but unfortunatly under the control of pain meds etc. What really gets me mad is that they want you back to work, but want to take away the meds. that are keeping me working. Especially If they will not repeat my carpal tunnel due to neuropathy. I am forced to live like this. I even had to give up my career of 15 yrs.
When I go to the hearing, I will have every one of you in mind when I speak for the IW. I am not a rude person, or angry person, i am thankfully a person that just likes to get my message across in a polite way and straight to the point. I will certainly let everyone know the outcome. Thank you again.