I went to pt today finally after not being able to see him for 2 weeks. I was suppose to see him 2x week but his schedule was always so booked, to day was the soonest. Anyways I told my worker comp md last week and she ordered for me to go to a new pt facilty but go to this guy until I get in with the new place. I go in today and he said i had no more visits left mind you i was just reordered 8 more visits and used only 3. He said he will call my case worker and had me work out on the treadmill in the meantime. He came back and said that she said there where no more visits and to call her. i called her as soon as i got out and she said since the doctor ordered a tens unit that pt was cancelled and my doc said i was not benifiting from pt anyway. Now I know my doc did not say this becasue i saw her order the new pt for me. And on top of all this the worker said the tens was apporved on the 21st of march, here it is april 3 and nothing, she said she would check on it for me. So in the mean time I gotta suffer somemore, just getting to the point where I ma getting better and felt that maybe at this point pt would work better. I will just have to cont. my walking. But i believe with all my heart that the case worker had something to do with this. I am pissed and so now no pt and no tens!

This same thing happened to me. Mind you, this was 6 years ago, so my memory of the details is foggy. BUT, THIS I KNOW...I had a WC Lawyer by then... and all it took was a letter, and I was back in PT. My "nice" WC MD was the one who told me to get a lawyer or I would miss out on good care. There is no charge until you win your case.

I'm convinced they just don't care. Someone at the insurance company sits behind a desk and makes life decisions for us. My therapy just got denied and I appealed. My denial got upheld. Their decision was that they could not justify further therapy because I am not getting better fast enough. Also that therapy is not to be used for pain management. I'm going to do a second level appeal but don't know what else I can say. I think I will research websites and attach info how therapy benefits. A few years before surgery I did back therapy and same thing that happened to you, I went in for therapy and they said to me "oh didn't you get our message?" The insurance company did the same thing, they ordered the TENS machine and kicked me out of therapy. Oh, my surgeon just ordered 8 more weeks of therapy. Doesn't matter. Insurance co. doesn't agree.

I'm sorry to hear you're having trouble with the insurance, kkmom! Is it your employer's WC insurance, or your regular medical insurance?

I have had good luck with my PT, who is in Simi Valley (I think that's about 50 miles from Hawthorne, and probably too far for you to drive, but they are a great group of people). I hope you can find someone close to you that is able to handle both the insurance thing and getting all the visits in when they should be done.

I'm convinced they just don't care. Someone at the insurance company sits behind a desk and makes life decisions for us. My therapy just got denied and I appealed. My denial got upheld. Their decision was that they could not justify further therapy because I am not getting better fast enough. Also that therapy is not to be used for pain management. I'm going to do a second level appeal but don't know what else I can say. I think I will research websites and attach info how therapy benefits. A few years before surgery I did back therapy and same thing that happened to you, I went in for therapy and they said to me "oh didn't you get our message?" The insurance company did the same thing, they ordered the TENS machine and kicked me out of therapy. Oh, my surgeon just ordered 8 more weeks of therapy. Doesn't matter. Insurance co. doesn't agree.

Hessie, another thing you can do is ask for a "peer review." That's something your doctor would do for you. He would talk to the insurance company doctors and vouch for you that this is appropriate and needed therapy. The insurance companies don't tell you these things because they don't want you to do them! It's still no guarantee, but if your doctor's willing to go to bat for you, it might get you more therapy.

Wishing you success,
Emily :wave:

Hi Everyone,
I'm not a WC case but I have had PT many many times in the last 4 yrs. All of my therapists have told me that if I dont' do the exercises every day coming to PT isn't going to really help very much. I know some things can't be done at home since we dont' have all the equipment they have. But you might want to ask what you can do at home that will be beneficial to you. I do certain things like pelvic tilts and other exercises all the time and they have helped by not letting my muscles be completley dormant. Please dont' feel that just because your not going somewhere you can't have a good pt program.

Good luck

God Bless

Carol

If I can ask again. do you have a laywer?

I did not know anything about it when I first got injured, but like I said, my WC nice MD told me under his breath that EVERYONE should get a WC MD. You have lost wages since the injury right? I'm not a go after people and sue type of person, but if I didn't, then , the longer I was injured, the worse the WC got. I was out for 10 months with my injury.... and after about 6 months, they got nasty. And I was sooo happy that I had the lawyer just to write me letters of protection and letters that allowed me to continue PT and seeing a Spine Specialist. And if you are Disabled at all, that is, for life, you should get compensation. It DOES NOT affect your affiliation with the hospital that you work in either. I went back to my job just fine afterwards.
Just want you to get the good care that you deserve...it didn't mean anything that my WC Doctor pushed for me with the insurance....it doesn't matter at all. He told me how hard he was fighting for me...but, again, under his breath...he muttered...lawyer.

Please seek a worker's comp attorney. Plus read your states comp laws they all vary. Here in PA. after 30 day's I see whoever I want to see to treat me.
babs I never heard of a workers comp MD . Unless it's one comp sent me to and I wouldn't trust anyway !.

Be Smart , Get an Attorney :wave:

Please seek a worker's comp attorney. Plus read your states comp laws they all vary. Here in PA. after 30 day's I see whoever I want to see to treat me.
babs I never heard of a workers comp MD . Unless it's one comp sent me to and I wouldn't trust anyway !.

Be Smart , Get an Attorney :wave:

Its the MD taht WC sent you to...thats what I mean by WC MD. They work FOR WC. But mine was a sweet guy, as Ive said.
But here here to what Shawley said.

kkmom,

Not to make you feel less assured, but Shawley was correct letting you know that your case worker is not your buddie but your worst enemy when it comes to work. comp, they just don't want to pay out the money, workers comp is on the employees side 99% of the time. I am saying this because of experience I went thru years ago after a car accident.
I hope you get some better results soon.

Duffy10
DDD 2005
Stenosis
L4,L5,S1 (Waiting for fusion surgery 4/11)

Thank you all for your responses. I never evne thought of a lawyer because initially I did not think this would go on this long. As strange as it may be I do not have a clue of what to do or where to start. I do now believe I need one after listenign to your stories and advice. So where do I start with the yellow pages? DO I pay out the pocket? I have little income being off and I worry because this is also my place of employment for the past 10 years and everyone is so wonderful except those crazy surgoens. I sometimes think I am making a big deal out of nothing esp. now since the pain is better. Do I still try to fight, because I may flare up again or just let it go. Thanks you all, but I am so clueless, Shawley I know you got a answer lol:)

oooooops had a brain-fart, I meant employers not employees. :dizzy:

duffy10

kkmom.
LISTEN TO ME....I CAN HELP YOU. I"VE ALREADY BEEN THRU THIS.

couple of things:
please write these down or remember...I did VERY WELL in my case for my WC injury

~you don't pay the lawyer until the case ends. The $ comes right out of your case...so you NEVER go into your pocket for Lawyer expenses NEVER.

~the lawyer does not start "working on the case" until you are back at work, and the "treatment ends"

~It protects you for the next 2 years as well...even if you went back to work tomorrow...the case is still open for a long time...meaning...if you are at work, and 7 months from now your back is bad again, all of those bills and that time out of work, gets totaled into your case. It can reopen in the 2 year protected period. . In NJ, you are covered for 2 years from when you go back to work

~I'm a nurse too remember, and THE SUIT DOES NOT AFFECT YOUR WORK THERE...as a matter of a fact, my boss was like "I hope you got something out of this b/c thats a shame that you got hurt here at work" you know we get bounced around a lot

~And like I said, even though I wasn't paying the lawyer anything, once they had my case...they had to represent me whenever there was a problem...EX. the no more PT orders. I was back in PT that same week.

~If you are wondering if you REALLY need to go thru all this? Questions for ya! Do you think you will need to take anything from stronger meds to Advil for the rest of your life b/c of this injury? If you said yes...they you deserve to be paid for a lifetime supply of Advil...do you understand? Another Q....Can you no longer do certain things? If you answer yes...then you are affected for life, and need a lawyer. Another Q....do you have any children to take care of? You lost wages while out of work...WC only pays like 60% depending on your state. You should get paid the rest.

~ITS NOT YOU BEING MEAN, Its you taking care of what you lost. A WC case is the EASIEST kind of lawsuit. All you do is find a lawyer, then they take care of the rest....you will get sent to a MD, and the MD will tell the courts how much disabled you are...% that is. Then they come up with a number, and your lawyer says yes to it, and BAM, its done. You get reimburst for your past and future losses due to your injury!

How to find a LAWYER: Yellow pages, word of mouth, billboards, advertisments in newspaper~thats my winning find for my guy

KK,
Look in your yellow pages for an attorney , please make sure you read your state laws on worker's comp. I'm sure your attorney will tell you. I haven't paid a dime yet , my attorney told me if he had to fight for a check or any other monies that he is entitled 20% of what he get's for me. States vary I think. I'm sure when and if I get my lump sum my attorney will be very happy with his payday , I mean come on a few letter's here and there and get a few thousand dollars for hardly any work ? I should of been a lawyer.:dizzy: Listen to me and talk to a lawyer you'll be happy you did.

Just remember every states laws are different so read up on it. :wave:

Babs and shawley you both are so wonderful. I really, really apprreciate your advice and i will start my lawyer search and all the wc info on monday. Thanks again!!

hey ...didn't mean to be pushy...just wanted you to be taken care of. They can be harder on women about this stuff so I just wanted to guide you a little bit...you know, give you the knowledge I got from MY OWN mistakes/mishandling of my case. Best of Luck!!!!

Hello I got new orders yesterday to see pt near my home. I am so gald. Just wnated you all to know

[QUOTE=BlueAtlas;2901466]Hessie, another thing you can do is ask for a "peer review." That's something your doctor would do for you. He would talk to the insurance company doctors and vouch for you that this is appropriate and needed therapy. The insurance companies don't tell you these things because they don't want you to do them! It's still no guarantee, but if your doctor's willing to go to bat for you, it might get you more therapy.[QUOTE=BlueAtlas;2901466]

The therapist says it is up to the dr. to contact the insurance. It is like no one seems to care. I'm doing my second appeal so will see how it goes.

[QUOTE=hessie28;2919601][QUOTE=BlueAtlas;2901466]Hessie, another thing you can do is ask for a "peer review." That's something your doctor would do for you. He would talk to the insurance company doctors and vouch for you that this is appropriate and needed therapy. The insurance companies don't tell you these things because they don't want you to do them! It's still no guarantee, but if your doctor's willing to go to bat for you, it might get you more therapy.[QUOTE=BlueAtlas;2901466]

The therapist says it is up to the dr. to contact the insurance. It is like no one seems to care. I'm doing my second appeal so will see how it goes.

Hessie, another thing you can do is ask for a "peer review." That's something your doctor would do for you. He would talk to the insurance company doctors and vouch for you that this is appropriate and needed therapy. The insurance companies don't tell you these things because they don't want you to do them! It's still no guarantee, but if your doctor's willing to go to bat for you, it might get you more therapy.

The therapist says it is up to the dr. to contact the insurance. It is like no one seems to care. I'm doing my second appeal so will see how it goes.[/QUOTE]