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Settled with open medical, need advice
#1
I settled last year in august with open medical, and I thought they were doing there part until I got a bill from the hospital.. It seems they have denied coverage, not authorizing meds e.t.c,. then the clinic and pharmacy turned it in to my private ins and they covered it. I would have not known there was an issue if I didn't receive a bill, and a few days later a itemized charges for the last 6 months my private ins sent me that they covered. I brought this to my attorney and this was back in jan, the only thing he done was call the wc ins and they claim they had no idea there was a problem.. The wc ins sent me medical release forms so they could see the latest records of treatments and meds. This was all back in Jan, with several calls to attorney and wc ins and to this day nothing is resolved and there still not covering my medical.

The way I feel my attorney got his money from my settlement and now he is bailing on his responsibilities. It's probably out of the question to get another attorney to fight for my coverage when there is no money in it for them.. Where do I turn, should I turn my attorney in to the state......?
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#2
the fight should be between your private health insurer and the comp carrier; you shouldn't be in the middle.
contact ther health insurer. you can send them your comp award and they can decide how they want to proceed.
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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#3
Thanks 1171, I will try that... I am frustrated that wc ins is doing this, I know its no big deal but its just the point of it.. Before wc started there games on not covering even way before I settled, there is one med my ins don't cover. It's not a med that's real important because its not needed daily but I cant afford it and they should be holding up the agreement.
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#4
I've found that fighting over principal rather then the practical -especially with respect to the law can be a frustrating and unrewarding exercise.
I would save your energy and sanity for those battles that significantly affect you and your health.

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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#5
Curious Bronco if you are on Medicare. Seems the IC doesnt want to settle medical because the will have to get approval from CMS and if they dont do it properly will be on the hook. They are playing games because they know your atty probably would bailed after the money part of the settlement and they know they can at least try to get away with it. I feel for you and this is why it is so important for the average american to vote for the right people to run their state - everyone get fixated on the presidentential elections but it is the house and senate for the state\congress that matters the most.

The people making the laws for the rest of us do not have to abide by the consequences so frankly they get away with bloody murder
 
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#6
We found out that when my hubby needs medical treatment that is to be covered by Workers Comp he only gives the Workers Comp insurance information and not his private insurance information. If the medical facility happens to have the information on his private medical insurance he just says oh I don't have that insurance anymore. That eliminates them billing your private insurance company. Works everytime. WC is famous for denying medications and treatments...it is part of their game. My hubby also settled with an open medical claim and has had no problems for the last 10 yrs and now he has a new case worker. SO of course she is denying every medication that he has been on for years. He has a pain pump in and the case worker denied that payment. Luckily his pain guy refilled his pump anyway or he would have ended up in the hospital with withdrawl. If you get prescriptions for you your work related injury have the doctor write right on the prescription that the medication is for such and such injury. We started doing this and it eliminates them denying a bunch of stuff.
 
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#7
(04-25-2014, 05:08 PM)1171 Wrote: I've found that fighting over principal rather then the practical -especially with respect to the law can be a frustrating and unrewarding exercise.
I would save your energy and sanity for those battles that significantly affect you and your health.

so if wc is refusing to pay my meds and procedures and it is less stressful to allow them to, if I did bring it to the priv ins attention they paid for wc liabilities could I lose my priv ins?
 
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#8
i was referring directly to the original poster's statement :"I know its no big deal but its just the point of it."

i think to you not paying your meds is a big deal and it more then just to prove a point so my comment does not apply to your situation.
I don't know your job/employment status so I couldn't comment on your private insurance coverage.

since you have a separate issue from this topic you should start a new thread.
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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