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W/C wants to buy out Lifetime Medical
#1
Hi Everyone! Its been a while since I was last on here so let me tell you what's happening... It's been 7yrs since settling, I receive an annuity monthly from work comp, plus lifetime medical, a monthly check from my employers long term disability company, and SSDI. After having the 3 level fusion, I always knew there was something wrong w/my throat/vocal cords, Drs kept telling me it was nothing, finally after 11yrs a DR finally listened and I was sent to a throat specialist: there is vocal cord damage from the surgery and could have been remedied if it was noticed right away (hmmm)furthermore any further surgeries will cause more damage... anyway, they also discovered the level that the surgeon was not willing to do at the time of surgery C7-T1 is now making its move, the Drs would like to do surgery. Start in the front then flip me like a pancake and put rod & screws in the back. With that said, I get a letter from my atty today saying Work Comp would like to buy out my Lifetime Medical asap, so I said what figure are we talking about...(silence)of course they want to buy out now that there's a pending surgery. SO my question is how do I figure what the buyout could possibly be.
HELLO to 1171, Cooks Family, Jayne, Bad Bad Boy etc... hope you all remember me Smile
Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.
 
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#2
Yes I remember you and welcome home.If you are having problems I wouldnt settle it would all go to medicare since you are on medicare.
........I love cats, I just cant eat a whole one by myself......







 
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#3
any number would always be a guess.
what if something goes wrong? medical costs can escalate radically.
the time for them to buyout the case was 7 yrs ago. they probably under estimated the future costs then.
but you can't decide on a fair amount until you hear a number from them and have a reasonable idea of what you will need.

Jayne is correct. there will have to be a medicare setaside acount set up and you will need to get their approval first.
and all the medical $$ will have to go be accounted for in your treatment before you can use medicare.
unless there is a problem with the comp coverage there may not much of an $$ advantage.
ask the carrier to conduct a life care plan before discussing any amounts.
here is a sample:
http://www.lifecarewriter.com/

but to answer your question:
talk to your doctor about what you need and costs;
get a list of the paid medical from the carrier so you have an idea of what routine treatment has been costing them.
do a medical budget for your life expectancy.
figure a both a good outcome and a poor outcome budget.
calculate a present value for each.
a fair settlement value should fall somewhere between the two.
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
They are wanting to buy out the medical to save themselves money, no other reason.

My medical was bought out when I settled, big mistake.

Mine was the left knee, total replacement.

I will never receive medical coverage by a private health insurance company
because I settled with closed medical.

Yes, I received a set aside, $4,600. Not enough for doctor visits or x-rays.

Protect yourself and settle with your medical open.



 
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#5
(01-11-2014, 12:13 PM)jayne Wrote: Yes I remember you and welcome home.If you are having problems I wouldnt settle it would all go to medicare since you are on medicare.

HEY JAYNE!!! I called the atty and said I wouldn't settle. With the pending surgery hanging over my head, I think W/C is just trying to cave on responsibility. Hope you are doing well...
Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.
 
Reply
#6
(01-11-2014, 12:31 PM)1171 Wrote: any number would always be a guess.
what if something goes wrong? medical costs can escalate radically.
the time for them to buyout the case was 7 yrs ago. they probably under estimated the future costs then.
but you can't decide on a fair amount until you hear a number from them and have a reasonable idea of what you will need.

Jayne is correct. there will have to be a medicare setaside acount set up and you will need to get their approval first.
and all the medical $$ will have to go be accounted for in your treatment before you can use medicare.
unless there is a problem with the comp coverage there may not much of an $$ advantage.
ask the carrier to conduct a life care plan before discussing any amounts.
here is a sample:
http://www.lifecarewriter.com/

but to answer your question:
talk to your doctor about what you need and costs;
get a list of the paid medical from the carrier so you have an idea of what routine treatment has been costing them.
do a medical budget for your life expectancy.
figure a both a good outcome and a poor outcome budget.
calculate a present value for each.
a fair settlement value should fall somewhere between the two.

Slow down 1171 Smile how do I do a medical budget/life expectancy and how do I do a present value...
I've called the atty and decided against the buy out, with pending surgery hanging over my head, I would be afraid that there wouldn't be enough $$$$$ to cover surgery, doctors, therapy, medication etc.. with the way the payment scale is for Medicare it makes me wonder how much I would have to come up with to cover patient responsibility. I looked at the website example of lifecarewriter.com I remember w/c sent me to a place for "The Functional Capacity/Return to work Evaulation" but there was no dollar figure attached to the report...
Anyway, I'll just keep doing what I'm doing but I have a feeling W/C will be strict (again) when I turn down the buyout.
Thanks 1171

Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.
 
Reply
#7
(01-11-2014, 12:48 PM)Bummer Knees Wrote: They are wanting to buy out the medical to save themselves money, no other reason.

My medical was bought out when I settled, big mistake.

Mine was the left knee, total replacement.

I will never receive medical coverage by a private health insurance company
because I settled with closed medical.

Yes, I received a set aside, $4,600. Not enough for doctor visits or x-rays.

Protect yourself and settle with your medical open.


Thanks Bummer Knees, I appreciate your advice, I have decided not to pursue the buyout since another surgery is pending...
Babebahn..."Tongues don't have erasers"
Injured 1999 3 level anterior cervical fusion 2001
Settled Work Comp Case 2006 w/ Lifetime Medical Currently, C7-T1 is being watched will possibly need surgery front/back fusion from C3-T2, lower back needs another facet injection.
 
Reply
#8
Sad 
(01-11-2014, 01:58 AM)Babebahn Wrote: Hi Everyone! Its been a while since I was last on here so let me tell you what's happening... It's been 7yrs since settling, I receive an annuity monthly from work comp, plus lifetime medical, a monthly check from my employers long term disability company, and SSDI. After having the 3 level fusion, I always knew there was something wrong w/my throat/vocal cords, Drs kept telling me it was nothing, finally after 11yrs a DR finally listened and I was sent to a throat specialist: there is vocal cord damage from the surgery and could have been remedied if it was noticed right away (hmmm)furthermore any further surgeries will cause more damage... anyway, they also discovered the level that the surgeon was not willing to do at the time of surgery C7-T1 is now making its move, the Drs would like to do surgery. Start in the front then flip me like a pancake and put rod & screws in the back. With that said, I get a letter from my atty today saying Work Comp would like to buy out my Lifetime Medical asap, so I said what figure are we talking about...(silence)of course they want to buy out now that there's a pending surgery. SO my question is how do I figure what the buyout could possibly be.
HELLO to 1171, Cooks Family, Jayne, Bad Bad Boy etc... hope you all remember me :)
 
Reply
#9
your atty should have settlement information.
you can also try here
https://abouthealthtransparency.org/repo...lth-costs/

remember: don't price for success. any surgery is risky as you've already found out. include corrective followup surgery and long term maintenance care as well.
most states have a fee schedule so look on your state work comp site for the doctors section on fees.
if you are medicare eligible, CMS wants to approve a Set- A -side amount so they don't get stuck with claimants that got inadequate settlements.
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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