Ohio here: C9 approved Work appeals??

[Dinah]

Hi
Okay finally after a year the MCO approves the C-9 for going to the pain management doctor and to the neurologist and my work appeals the approval. Why? What's the point of having the MCO approve if they're just going to appeal? I made the appoitments and I guess workers comp will have to pay for the visits since they are approved right? The thing is all I have ever wanted to do is get the chance to see the doctors that may help me and go back to work and yet my work fights it every step of the way. I can't understand. I did approval to see the physocologist once a week for three months for the depression and the post tramatic stress that have been added to my claim. I still am waiting for approval to have the brain injury addressed even though head injury has been added to the claim. Honestly my experience with the whole workers compensation gig has been such a dissappointment. And now they the MCO or work or someone has decided I don't need the medications I take so they put a do not pay for them on my claim. So I have to pay for them because they are not medications you are suppose to stop taking without being taken off them slowly. Wouldn't you think the Nurse that works for the MCO would know that or does that not matter? There are so many things that happen to injuried workers after they are injuried that I can't understand how Workers Compensaiton is for the employee and looking out for their health. Doesn't seem that way to me or am I wrong??? Sorry just frustrated and ranting. How many appeals are there to an approved c-9 anyway?

[Bad Boy Bad Boy]

Dinah, 1st I say welcome to the Board.

2nd may I ask what is MCO?

I feel for the mess you in. I know, if ReddandSassy were around, she could give you great information on your State of Ohio, and how to try and handle these issues.

I'm with you, how in the heck, or what gives anyone or company, the right to say you should stop taking a Medication that could then cause a serious body malfunction? I myself also had to deal with that also. One of these days, I must ask my Attorney about that issue. I keep putting that question off, then I forget to ask. So, I must say, your case woke me up again on the Medication issue.

Please keep us up to date. And you also might wish to make a Post / Thread addressed to ReddnSassy from Ohio.

[Lilly]

Hi,
My question is too....what happens and who pays if you were forced (by company or WC non payment) to abruptly stop taking a med (that has warnings about stopping abruptly) and you had serious health consequences because of it? Who is responsible? WC should be held accountable, but I'm sure there's some loop-hole as to why they aren't!
Your situation absolutely sucks, and is similar to most others on this board....yet is allowed to go on.
Take care & prayers to you. Lilly

[1171]

Work comp issues can be appealed to the civil court system so technically the last level for either party is the supreme court.

[whatamess]

Dinah Wrote:Hi
Okay finally after a year the MCO approves the C-9 for going to the pain management doctor and to the neurologist and my work appeals the approval. Why? What's the point of having the MCO approve if they're just going to appeal? I made the appoitments and I guess workers comp will have to pay for the visits since they are approved right? The thing is all I have ever wanted to do is get the chance to see the doctors that may help me and go back to work and yet my work fights it every step of the way. I can't understand. I did approval to see the physocologist once a week for three months for the depression and the post tramatic stress that have been added to my claim. I still am waiting for approval to have the brain injury addressed even though head injury has been added to the claim. Honestly my experience with the whole workers compensation gig has been such a dissappointment. And now they the MCO or work or someone has decided I don't need the medications I take so they put a do not pay for them on my claim. So I have to pay for them because they are not medications you are suppose to stop taking without being taken off them slowly. Wouldn't you think the Nurse that works for the MCO would know that or does that not matter? There are so many things that happen to injuried workers after they are injuried that I can't understand how Workers Compensaiton is for the employee and looking out for their health. Doesn't seem that way to me or am I wrong??? Sorry just frustrated and ranting. How many appeals are there to an approved c-9 anyway?

Dinah,

This is the appeals process on a denied C9: 1st level appeal, (normally your por or aor does this); 2nd level appeal (same as 1st) please note, the 1st & 2nd appeal are to the MCO; then the MCO will send it out for a Peer Review. The reviewer will agree or disagree with the requested treatment, if he disagrees (which i am sure he will) then bwc will issue what they call an ADR order...at this point this order needs appealed to the industrial commission and on that appeal, a hearing will be set.. you will need a report from your doctor to rebut the Peer review and to support the requested treatment.

I wish you the best of luck and hope you get the treatment you deserve...

[Still in Limbo]

Hi Dinah! I'm in Pa., and the only way they can Legally take away your Meds. (W/C that is) is to file a Utilization review Petition to the w/c Judge to have a panel of Dr.'s look over your Meds. and give their expert opinions on whether you need them. If they succeed, you can file an appeal, and you have an opportunity to have a Depo. taken of your Dr. and the Judge decides. They can't stop you cold turkey. If you don't have Counsel, now is the time, if you do, they need to get to work on getting you re-imburse for your Meds.!! I Hope this Helps a bit, and I wish you the Very Best!!