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Denied physical therapy?
#11
my nurse case manager was throwing a fit to me on the phone, that they have to CONTACT HER for physical theripy approval, and pre-authorization. I called the adjuster (finance lady) on my case to get the fax number to send my mileage request, and just happened to mention this to her.
She told me that the NCM CAN preauthrize stuff like this, but one month post op.... SHE approved it already (seems they already had HER number, not the NCM's number). I will add the NCM's number to my records when I fill out the paperwork today at physical theripy. But if they can not agree on protocol within their own company, WHY drag he IW into it all...

I would tell your husband to contact his lawyer and have them send you guys a new medical release form. You need to be able to take care of your husband when he is unable to, and with the proper release form filed they CAN NOT refuse to work with you, when you are just trying to help. Honestly tho... if you have a lawyer, you need to be going through them for answers to things. DO NOT contact the w/c directly.
[IMG]http://i185.photobucket.com/albums/x148/dipweed23/Bananav2.gif[/IMG]
Avatar thanks to WINK!
 
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#12
1171 Wrote: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

We are in Alabama.
 
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#13
frustratediw Wrote: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.

24 visits - wow that is not a lot. My husband had to have physical therapy after the initial accident - jsut to get it to where he could walk again. Then, once his heel had healed enough they did surger to fuse his ankle joint (had to wait to make sure there was something there to put the screws into - he completely crushed his ankle joint and shattered his heel.) Now we are into physical therapy after his surgery - he still is not walking to well. I can't even begin to think of the number of visists he has already had.
 
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#14
Wink
Yes alabama is one of the states that has added extensive utilization review and medical management requirements
Smile
see their website for details:
http://dir.alabama.gov/wc/umbs.aspx
Rolleyes
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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#15
After reading alot of these post i feel i am sorta lucky in some ways by never having trouble with PT or OT limited visits. I have been going to OT 2 x's a week for 6 months and then started PT with OT 2 times a week. So that is a total of 4 visits a week for almost 6-7 months. During my OT visit i was having TENS unit treatments on my hand/wrist that the doc finally signed a paper for OT to purchase one for me to take home. I just recieved a call yesterday to say that my I/C purchased the unit which cost 800.00. It is mine now to keep which i am very excited about as it relieves me when i am in so much pain that nothing else works. I also got a call from the co. that they purchased it from to offer me more pads and wires if needed. Today UPS just dropped off a package with 5 more packages of pads to use which probably will last me many months ahead. It is all covered through w/c.

Last last time i met with my CM and my occupational doc, the CM asked me if i would like to continue with OT or not. I figured that they really were not doing much for me, and with the TENS unit there was no need for me to drive there for 30 min sessions when they were doing the TENS unit and ultrasound treatments. I have 2 PT visits left, and actually found that i am feeling alot better since i started it, and cannot wait till those are done with also. Just driving with this hand to get to my appts. 4 x's a week caused so much stress and pain to drive that far. I live in NH and i asked for all my records for PT/OT from the hospital and saw i had well over 30 visits and they would of kept continueing if i did not agree to stop them. I do have the choice they said if i get really bad i can go back for more treatments and to just let them know.

I really wish things went so smoothly for other people on w/c, as it is bad enough that we are in so much pain/depression from our accidents that having to fight for treatment only makes matters worse. I would really check into how many visits you are allowed, and i feel that if the doctor orders that treatment that w/c cannot deny your treatments. My CM wanted to get me off a antidepressant awhile back as it cost alot of money. She did not come right out and say it, but dropped hints every now and then as far as " does it work?" told me how much they pay per month etc. I am still taking it today, as my doctor refuses to take me off it. She has stopped dropping hints about the drug now. I cannot stress how lucky i am to have a adjuster that pays on time, and a CM that comes to my appts. but does not cause me any misery. I wish you all luck, and remember to fight for what you deserve to make your health better : ) It is your body that you have to live with the rest of your life, and your pain.
carpal tunnel recurrence/ neuropathy / RSD.
1/29/07 injury date. Permanent. PIR settlement 8/4/08 10%
 
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#16
Get a lawyer they stopped paying my chiropractor for 6 months ask the lawyer to make a trials date i foung that once a lawyer is braught in things change never ended up going to trial even lawyer worked some magic and they started being payed again all the way back to when they stopped till now. get a good aggressive lawyer in this game you need a shark not a goldfish.
Hope everything turns out good .
I have been out going on 2 years it is nothing but a stressfull mess.
 
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#17
I have had a similar issue in GA. I fractured my arm at work back in May 2014. Went to the adjuster picked Dr. he was awful but by the 4 week he asked for physical therapy which the adjuster never approved. Finally I asked my lawyer to help out and he was able to get a 2nd opinion Dr. He prescribed 8 weeks of P.T. and if it didn't work then I would need a manipulation.
As soon as the adjuster saw that I finally was prescribed P.T. I arrive there and guess how many days was authorized. Not 3 weeks like the 1st Dr. wanted to 8 weeks like the 2nd Dr. only 6 visits.
So during the therapy my therapist tried to reach my adjuster with no luck. My lawyer even tried to reach them to extend my therapy still no luck. Now it is Sept 2014 and I have only done 6 days of therapy. I have a frozen shoulder because of it.
Still not sure what will happen. My lawyer just set up a court hearing in October to try and make the adjuster do something. I don't want to settle yet because I can not move my arm. I just want the adjuster to approve for me to get better. Frustrating!

 
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#18
your health insurance will often supply care that's denied by workers comp.
you are allowed to self-procure care when it's being disputed by comp and submit a claim for reimbursement later.
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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