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Shoulder saga continues
#1
Hi all It's been a while since I've been here *waves*

I was able to have surgery on May 24th for my impingment/frozen shoulder. Pain is there just diffrent, ROM is about the same! My right shoulder is now loosing ROM also.

Anyway I have a delima! Since workers comp denied my claim I have had to use my insurance for PT. I am only allowed 30 visits per year. I was trying to figure out how many I had left when I discovered a bit of fraud.

Seems the PT place is charging my IC for ultrasound every vist but I have only recieved this treatment on what was my last PT visit. I am pissed because this is a treatment prescribed for me that i'm not getting. I really like the girls at the PT place and feel betrayed. I have since stopped going I just cant afford the 30per visit co-pay. I don't know what to do. Should I inform IC? Who would belive me? my husband has sat through a few of my sessions but really who would belive that? Should I just forget about it no biggy who would choose a big IC over a small town local business?

My first hearing went well, another in Oct. My IME is scheduled for the 26th joy o joy, any advice?

I can't get my Doc to acknowledge that my right shoulder is in trouble also!! Since my last visit I have begun to loose ROM!! All he did was yell at me for not using my left arm enough.

Thank you for your time!
 
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#2

Hi Isabo........I can't answer your questions but wanted to let you know you are not alone. I also have frozen shoulder but have not had surgery to fix it and hope I never have to. PT has made me worse. Ultrasound is great for our problem but I have had to ask for 8 weeks until I finally got it last week. Only once. I am also using my own insurance. Have 60 consecutive days. !st I went after surgery and then when the dx changed to frozne shoulder that gave me a new dx and a new 60 days. My prayers will go up for you . I know it's a nightmare and so frustrating. Not to mention the pain.


CAP
 
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#3
Isabo

You can always go 2 routes - speak to the billing department of the PT office and explain that you have only had 1 ultrasound and you notice that they are billing the ic for one each visit and feel that this needs to be corrected by them submitting new billings to the IC. At least give them the chance to correct it - if they don't

Then contact the IC and explain that you didn't get the ultrasound but once and feel that they shouldn't have to pay for treatment that you didn't receive.


As far has having problems with both shoulders go - normally a doctor will only address the problem with the one that is giving you the most problems - it's up to you to make sure that they are documenting that you are having problems with both - so make sure that you are heard!!!!!

I have problems with both shoulders - but since I have kept range of motions - doctors say that surgery is out of the question as it will do more harm than good for me - that I just need to live with the pain at this time.
 
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#4
I'm not able to discuss the insurance issues, except that you need to have a lawyer involved at this point. If you where hurt on the job WC should be paying for everything.
On the billing side of things, do talk to the billing person, ask to see your records (they ARE your records) and have them correct them if a treatment is listed that you did not receive. Again if you must, you can get a lawyer involved, if you tell your insurance not to pay for the treatment, they will bill YOU. It is best to let the IC pay the bill, then when they send you a statement saying what they paid (my health insurance does this even for simple Dr Visits) dispute it with them. They will get invloved in possibly sueing the PT place.
If they are billing inaccurately, it's time to find another PT place too. They should be having you do excersises for BOTH sholders, to keep the other arm strong and flexable. It's possible to get a little sore, depending on the uninjured arm so much. Just heat and ice alternately and do light stretching and excersises to keep it strong.

Nobody can stress this enough:
SHOLDERS TAKE A LONG TIME TO HEAL
You said Surgery in May, I'm supprised they are even testing your ROM at this point. I'd think no more than a few degrees in external rotation and probably not higher than straight out in front of you.... Even those movements would probably be expeced to cause pain at this point.
I posted something regarding recovery of a bankart repair in the OT section. Take a look at it regarding what many sholder injurys take to heal.
[IMG]http://i185.photobucket.com/albums/x148/dipweed23/Bananav2.gif[/IMG]
Avatar thanks to WINK!
 
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#5
Whether they believe you or not, is their problem; but as a responsible patient you should at least let the prescribing doctor know. It sounds like there are more shennaigans then just the ultra sound going on. PT is one of the most overperscribed and abused therapies used by the medical community; a $30 co-pay seems excessive. If you don't let the carrier know at least tell your doctor.
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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#6
Thank you all for your replies!!!!!!

Cap~~~ I am so sorry to see that you are going through this too, I would only wish this on my ex-husband... LOL... Have you continued working? If so what kind of work do you do? What phase of FS are you in? How long has it been?? So nice to know someone else with this problem
 
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#7


Big GrinBig GrinBig Grin

Hi Isabo........ LOL i love the idea of giving it to the ex-husband but to be honest I would rather give it to my boss. I haven't worked in a little more than a year since being injured. My shoulder is only one of 5 injured body parts. Had surgery this past April. 10 bone spurs, removed, part of the acromium bone taken off and a 2 inch rotator cuff tear. Was doing wonderfully until an aggressive PT yanked my arm. 10 weeks post-op the surgeon told me I had frozen shoulder. 2 steroid injections and working it but stopping when the pain starts has helped me immensly in the past 2 weeks. I'm taking it slow, stop when the pain starts, and I seem to recover faster from the work out doing it that way. I'm not sure what stage I'm in. I would assume the frozen stage as the pain has gone BUT I have really good ROM and from what I 've read you have no ROM until it starts to thaw. I'm very confused by it all. Sorry you're going through this also. Horrible pain. The worst I have ever experienced and I had 3 children , natural childbirth. This was worse. Did alot of lifting and on my feet all day on the job. There is no way with all the injured body parts I would ever be able to do it again and don't know how willing I would be to put myself through this pain and the hell of WC again. God be with you.

CAPSmile
 
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#8
1171 and dipweed along with the others have given you very goo advice! I would at least speak with Billing, and if they don't change it, I would speak to the i/c. You have this knowledge of wrong doing, and if you don't try and act on it, they may try and say you were involved with this scam also!! I would make everyone know you are aware and you want this resolved, and I would start looking for a different PT to deal with. Just my opinion, but when you can't trust a Professional you are dealing with, it's time to move on and find one you can trust! Best of Luck, and I hope you get this resolved!!Wink
 
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#9
Hi.
If you inform the IC.....they will surely investigate , as they certainly do not want to pay for services not rendered. Your PT is NOT following your MD's orders/perscription...i would make them aware, and insist they start practicing the prescribed orders, as it's no different than a pharmisist giving you some other med in place of what was described and ordered. I would call it negligence!
Take care, LillySmile
Injured worker, & tired of it all! I'm too old for games!!

A careless word may kindle strife, a cruel word may wreck a life, a timely word may level stress, and a loving word may heal and bless!
 
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#10
My biggest concern for you is the IME is just NOW taking place. In PA the IME is to be scheduled within 45 days of the first hearing not a year later. Do you have an attorney helping you? If so, why is he/she allowing the exam and this late juncture.

Also in PA, if you have private Insurance, you should be getting medical treatment billed to WC carrier as the primary carrier and the private insurance as the secondary carrier. Once the WC carrier denies the bill, the secondary carrier is required to pay the bill. If WC is then found responsible, they can fight out who pays and you get reimbursed and co-pays you have paid.

Often a "letter of protection" will allow you to treat without any co-pays while they are billing the WC carrier.
 
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