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Think it's time to close Medical (NY)
#1
I've been trying to get something... anything done to try and help lower the pain in my lower back... but it seems no one wants to do anything about it...

Surgeon: says surgery is not needed and will not do it..

Surgeon's PA: says nothing is wrong with my lower back.. nothing we can do about it..

PM Doctor: put in a shot request over a month ago, someone sent it to the wrong place, they resent it on Sept. 4th and still no word.. I sent PM a message and it's been over a week and no reply.

All this and all 3 have all records and the reports & scans from ER in May showing 2 discs gone and pinching off the nerve, 3rd is almost gone and 4th has a bulge in it... PM dr. wanted to know why I haven't had surgery yet and I told him what surgeon and PA both said.  It's enough that both my legs are weak more then I like them to be and feet that feel like they just came out of the freezer isn't helping either and the stabbing pain from spine to both hips... but according to PA and surgeon.. there is nothing wrong...

I could go get a second opinion on this, but everyone is so booked up, I would be waiting 3 or 4 months or more...  I would also love to get a second opinion on my neck surgery because I shouldn't be getting pressure headaches every other day, bad tendon & muscle pain and the nerve problem down my right arm and hand.

As it is, I'm pushing myself to do things around the house, on vacations and everything.. then really regretting it at night.   My family doctor had to change out my sleeping pills and put me on something stronger because the pain is once again keeping me up at night...

So with talking with my husband, he is agreeing that I should just close it out and be done with it.  But since we never know if I would need the surgery in the future, this isn't going to be closed cheaply...
 
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#2
Just an update.. Pain Management called yesterday. They say the Ins. Carrier is denying any and all shots plus pain meds because they deem it NOT Medically Necessary...
When I settled the "work" part and kept medical open.. I asked my lawyer what makes us so sure they will approve of anything now?? And I was right... treatment is denied and they also put in for a MRI which was denied...
 
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#3
I don’t expect the carrier Will be eager to settle any time soon.
Reminder :
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THANKS FOR POSTING.
 
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#4
(10-11-2018, 08:42 AM)tbear6410 Wrote: Just an update.. Pain Management called yesterday. They say the Ins. Carrier is denying any and all shots plus pain meds because they deem it NOT Medically Necessary...
When I settled the "work" part and kept medical open.. I asked my lawyer what makes us so sure they will approve of anything now?? And I was right... treatment is denied and they also put in for a MRI which was denied...

Nightmare.


Have they checked your SI joints?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
Can you get your prescriptions paid by private insurance or Medicare as they are now denied by WC? I think we discussed this before and they would not cover it?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#6
Scripts are no problem.. but I've tried having Medicare cover the shots and they deny it too.. their reason is it's a Comp claim and they won't pay for it until I close medical out and use up the Set Aside...

I did end up at the ER yesterday, stabbing pain in my lower back and my right leg gave out while I was on stairs. 10 to 15 x-rays and no breaks or fractures.. but did bruise up the tailbone. They gave me a morphine shot and that only lasted maybe an hour.. When I got back home, I did notify my lawyer, pain management and the surgeon... I do have an appt. on the 23rd with PM again...
 
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#7
The only time I have read about a problem is when Medicare is secondary to spouses private insurance. I am sorry if I asked this question before, I just do not remember if you are covered by private insurance too? If so Medicare is considered secondary and will not cover until private insurance pays first. This can be a problem if private insurance refuses to cover it.

So many injured workers use Medicare for denied treatment from work comp on conditional payments. It has to be on things Medicare normally covers. I do not understand why you are having such a problemSad
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
Hubby has State Ins. right now until June 2019.. He just went full time at his new job and has to wait 90 days before he can get on whatever they have... For me, I only have Medicare and sup ins. with them.. Comp says to have Medicare pay and Medicare says Comp is to pay...

Calif... it's always this hard for anything with Comp and even Medicare in NY.. they love to give you the runaround.

I got a message from my family doctor that I need to see either my surgeon or his PA.. says the neck x-rays have really changed since the last time they were done. And not for the good.. The PA has messaged me and we are trying to get copies of the report faxed to her and the hospital is going to mail them the CD of the x-rays taken from neck down to lower back. ER doctor and my family doctor both say the fall caused movement in the rods and screws.. and since the fall was caused from the lower back injury, Comp should cover it.. Yeah.. we'll see....
 
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#9
Sad 
(10-15-2018, 02:27 PM)tbear6410 Wrote: Hubby has State Ins. right now until June 2019.. He just went full time at his new job and has to wait 90 days before he can get on whatever they have... For me, I only have Medicare and sup ins. with them.. Comp says to have Medicare pay and Medicare says Comp is to pay...

Calif... it's always this hard for anything with Comp and even Medicare in NY.. they love to give you the runaround.

I got a message from my family doctor that I need to see either my surgeon or his PA.. says the neck x-rays have really changed since the last time they were done. And not for the good.. The PA has messaged me and we are trying to get copies of the report faxed to her and the hospital is going to mail them the CD of the x-rays taken from neck down to lower back. ER doctor and my family doctor both say the fall caused movement in the rods and screws.. and since the fall was caused from the lower back injury, Comp should cover it.. Yeah.. we'll see....

So sorry you are going through this
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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