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And The Fight Begins.... NY
#31
Saw my PA at Pain Mgnt. yesterday. We gave her the paper from Comp and she reads it, looks at me and my husband and asks.... "Are They Serious???" Unfortunately, Yes.... Wants to know how anyone is suppose to treat me if they are denying everything. Good question asked by many.....
She showed us the famous C-4 form that was filled out twice by her... she had everything under the sun on it for my lower back and all the new symptoms.. she also saw the 6 from my surgeon... 4 on MG-2 form and 2 on the C-4 form... he had more listed than she did...
Had me schedule another appt. for the end of October and is going to put in her 3rd MRI request... I honestly asked if she thinks it'll be approved... Ohh and she also got the denial for any and all injections too...
Husband asked... Since the Carrier is denying all this stuff, isn't is a waste of time filling out all those forms? And if they are denying a simple MRI, what makes you think they'll approve surgery if it's needed? She couldn't answer that... But she did say if they keep denying everything, there really isn't anything more Pain Mgnt or even the Surgeon can do.
So a call to the lawyer's office was done when we got home... and another call a couple minutes ago... If no call back from his office by 6pm when his office closes, we are just driving there on Monday....

1171... if I settle and close out medical, how should I do it so I don't loose my SSDI, Medicare or Aetna? This is all in NY... I figure if nothing can be done, I might as well use that money to pay off bills and live off it...
 
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#32
You will have to pro rate the disability portion to avoid the 80% offset. Medicare wont pay for your work injury treatment until your medical settlement $$ are exhausted.
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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#33
Figured that.... So I guess I will need to have my new surgeon give me a rating (last surgeon has me at 75%) and then go from there??
 
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#34
You need your doctor to declare you at MMI before any new rating will be considered.
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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#35
Thanks for the help.... I'm back at his office at the end of the month and will talk to him about this.
 
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#36
How stupid can some get???    Talked to my lawyer today (he's one of them) and told him what I'm wanting to do...  He said my surgeon and anyone else I see NEEDS to put in a C4 to get that MRI... I told him 2 surgeons and 2 different Pain places have all done those stupid forms and get denied every time...  He says the UR doctor is going by that MRI they have and say there is nothing wrong or new...  Ummm you mean the MRI from 2014????    I mean, come the heck on.....  of course that old one isn't going to show anything new...  Ohh and they are going by my last CT Scan too.. Ohh you mean the CT Scan that was done in 2013??  Of course that's not going to show new stuff...    Did anyone at that hearing actually ask for the dates on those things?
I also brought up when I was in the ER from that fall last year and the Carrier didn't pay for it and was sent to my private insurance...  I also had a copay too...  Lawyer wants a copy of them...  umm yeah, it went through an insurance I don't have anymore and they don't have anything for me.. looked on Carrier's site and they deleted all my bills... so messaged the hospital to see if they can find it and send me a copy..
I then asked how come I'm not getting copies of those denials..... umm no clue...

My day has been so bad, hubby brought me flowers after he got out of work....

Update.. surgeon's nurse calls.. she agrees with me that the appointments are a waste of time since the carrier is denying any and all stuff. I asked her what forms are being submitted.. The famous C-4 all the time.. same with Pain Mgmt.. She says it's up to me if I want to keep the appt with surgeon's nurse next week, but there's nothing he can do.. So lawyer is going to be told to start the paperwork to close out medical.... Maybe my blood pressure and blood sugar numbers will go back to normal without all that stress...
 
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#37
I am sorry you are going through this tbear.
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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#38
Me too Calf... I'm so done with all of it. Between me and hubby, we did up an email to my lawyer explaining why I want to close the medical and hoping to not do a MSA, not mess up my Medicare or Ins.. or mess with my SSDI checks.
I saw my surgeon yesterday for a different thing and he said the 7th request he put in a couple weeks ago and the 2nd one Spine & Wellness put in, both came back denied. So why keep making all these appointments when neither place can do anything.
 
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#39
Found out that when I had the accident on the stairs last October and was in the ER... they were told this was under comp... Billing got in touch with me last week about that bill... they said IC refused to pay for it even though the fall was due to my lower back. They were nice enough to send me a copy of the bill and my old insurance paying for the whole thing... plus it shows my 90.00 copay I was made to do that night..
All was sent to my lawyer by email 4 days ago... no word on it... same as no word on us sending him that email about wanting to close out medical. Once again, if we don't hear anything by this Friday, we go to his office. It seems to us that he's not really doing or fighting for me.. and it's too late in the game to even think about another lawyer...
 
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#40
Well... still waiting for the call back from lawyer... That's getting tiring... I called pain mgmt to ask about the copies of the MRI requests that were put in twice.. Wanted the copies for my records and to show the lawyer.. They tell me the requests were never put in... Ok, then why were we told on my second appt that the first one was denied and she was sending in a second one? No one knows.. Ok, then why were we lied to? No one knows...

I guess no one knows anything....
 
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