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Denied physical therapy?
#1
Has anyone ever run into a situation where w/c won't approve physical therpay perscribed by the doctor? My husband has been going to physical therapy three times a week since he came out of his cast after an ankle fusion. At the last follow up doctors visit with the surgeon - he wrote another perscription for continuinig physical therapy but reducing it to once a week. The physical therapist has been trying for almost two weeks now to get approval from w/c for the therapy visits-but to no avail. My husband does have a vocational assesment coming up on Sept 4th and we wondered if that played into the whole equation......
 
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#2
I NEVER FOUND OUT WHY THEY STOPPED MINE (I HAD 6 MORE DAYS)
CASE MANAGER JUST DID.
"Laughter is the tonic, the relief, the surcease for pain"
 
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#3
Only the Great W/C Kahoona in the Sky understands why they do these things!! I would suggest either you or your Attorney, however it is set up, contact your adjuster and stay on them until you receive an answer, They may have not gotten the Dr.s Report, they may be being Lazy, someone may be on Vacation, and the list goes on. Just stay on them until you get what the Dr, has prescribed, or at least a reasonable answer why you aren't. It's a shame that the I/W has to be so active in this system to get what is theirs, if you wait for the i/c to act as they should, we wouldn't receive half of what we should! Best of Luck!!Wink
 
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#4
they refused mine also...............turkey buzzards
........I love cats, I just cant eat a whole one by myself......







 
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#5
While that hasn't happened to me, yet, I have a feeling it might be coming.

When I saw the IME last week he said he didn't feel PT was helping and I should have been out of PT 4 months ago (I have been in PT since Nov 06). Of course he didn't have any of the July PT reports (that showed minimal improvement, but improvement none the less) or Dr reports ordering PT to continue for another 6 weeks, through the third week in Sept. Apparently I tend to plateau and then continue to show improvement on a regular basis.

It might be that the IC have a set number of PT visits that are normally prescribed for a particular injury, and after that number is hit they will no longer approve it. Or maybe your DH has reached a plateau and the IC feels he won't go any further. Add to that your DH's upcoming assesment, and you might have the reasons. It doesn't seem right though, since your DH's Dr has prescribed more PT, that the IC can deny. I know in my state IC only has to approve things that are considered reasonable and customary, don't know your state or your states laws, though.

The WC nurse that goes to my Dr visits also went to one of my PT appts. She asked my therapist why I am doing any overhead exercises if I am back on the job ( I was at that time working with very restricted overhead duties) because I can get the overhead exercise while I am working. After the therapist explained to her the differance between the exercises and the actual work using overhead she dropped it. My therapist did tell me that it isn't unusual for WC to question and try to stop PT because it is expensive.

I have a pully at home, that was paid for by WC, and my therapist gave me some of the bands to be able to do exercises at home. Problems was I was doing too much too fast (but was only doing what I was told to do at PT and at home) and since they slowed everything down (came to be that since I am heeling so slowly, due to the nature of my injuries, the amount and type of exercises I was doing were doing more harm than help) I haven't done any exercises at home. Maybe there are some exercises the therapist can give to your DH that he can do at home to keep his progress going.

The WC nurse did at one point tell me, after I asked just how long she thought I would be in PT, that after PT was completed I would be expected to continue to do some exercises at home that would be given to me by the therapist. Perhaps the IC feels what he needs to do can be done on his own at home.

I have had an attorney since I was injured. Don't know if your DH has one or not. I'm not sure if that has had any effect on the IC complying with what the Dr's have ordered, but my gut feeling is that it very well may have. The funny thing is the only reason I even hired an attorney is because the case manager told me the week after I was injured that I should direct all of my question to her (she isn't even in my state and I've never even met her and probably never will!) and not to the Dr. Perhaps her desire to control my recovery ended up taking away any control she might have had if I had not hired an attorney.

dsny1mom
 
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#6
Yes, we have an attorney (just hired a few weeks ago). My husband spoke with the physical therapist this morning to see if he could recommend something - he said that he doubted the attorney would be able to get w/c to do anything - but we may be able to if we contact them about it. Another thing to vent about - the w/c case manager told my husband to quit having me call them because they will not speak with me, they will only speak with him direclty - spouses have no right to any information??????? Anyone else run into this? I can't believe that I have full access to all of my husbands medical records and can make decisions on his behalf but w/c won't talk to me!!! It just makes me mad.
 
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#7
It's very common for the Spouse not to be given info., only the Injured Worker or Attorney can usually obtain the info. on a Case. The Wife may be Divorced from the Husband, or anyone could call and say they were Related, so a certain measure of Security has to be used. Medical Records and Conditions are Confidential, and when dealing with w/c you are dealing with injuries and Care of the I/w, and they afford the same security and safety of Records as Medical Records. I Hope this clears things up a bit for you!!Wink
 
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#8
Still in Limbo Wrote:It's very common for the Spouse not to be given info., only the Injured Worker or Attorney can usually obtain the info. on a Case. The Wife may be Divorced from the Husband, or anyone could call and say they were Related, so a certain measure of Security has to be used. Medical Records and Conditions are Confidential, and when dealing with w/c you are dealing with injuries and Care of the I/w, and they afford the same security and safety of Records as Medical Records. I Hope this clears things up a bit for you!!Wink

Thanks - it just upset me at the time because my husband had fallen and possibly done some damage to his ankle again. When I called the doctors office to see what he needed to do - they told me to call his case manager. So I did. After leaving a message for them, they finally called my husband three days later and told him that I could not call them. All I was trying to do was see if we needed to get him back in to see his doctor to make sure everything was okay or what. This is actually the second time this has occured. The first was when we were trying to get the correct forms for medical mileage reimbursement. My husband had called several times (and left messages because they seem to never answer the phone) to no avail. Then I tried one day and actually got someone to answer - it was not his case manager but they were able to help (just got the address to send the forms to). My husband got a phone call from his case manager the next day chewing him out about me calling. It just doesn't make any sense to me. I understand about the whole confidentaility thing - but I have not been trying to get any personal information from them.
 
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#9
Smile
Some states have limits on the amount physical therapy and/or use medical review procedures to control medical costs. Your husband might be in one of those but without knowing your location that's a guess.Wink
Send them a power of atty - Confidentiality laws are much stricter these days.
Sad
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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#10
Not only have I been denied but had one instance where it had been approved and I had actually started. I showed up for something like my third of six "approved" appointments and they were on the phone with the adjuster and being told they had made a mistake and the physical therapy was not supposed to be approved. Talk about confusing. They did agree to pay for the appointments up to and including the one I was standing there waiting for. By that time I wasn't fazed just because that sort of treatment by the insurance had become pretty normal. I know in California physical therapy is capped at 24 visits. That does not mean you will get that many but that is the maximum allowed. My understanding is that in some rare cases the doctor is able to get more approved but it is difficult.
 
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