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Career Ending Operation???

Not sure why there would be a sudden denial for PT. Maybe Align Network/OneCall possibly passed on conflicting late info. See they are always one step behind.

That's what happens when you have too many hands in the pot and total lack of communication.
You start getting a whole bunch of confusing and conflicting information.

At this point the only people I would communicate with is the attorney and the doctors office.
Anyone else is just stirring the pot of confusion.
Normally if your doctor sends an order in for a certain treatment to work comp, you and maybe your lawyer would get an "approved for treatment" letter in the mail.
If know your doctor sent in an order and it's been awhile, you would either contact your attorney to make the call or you call your surgeon to inquire what the hold up is.
When you get an approval...that's when you should go schedule the treatment. If it's done prior to an approval, jusst to be proactive, people start getting confused.
 
well i can tell you, that i never get anything in the mail.

it is always done via phone...

i will happily go to therapy, i am looking forward to it, so that i can improve my situation.

i always call the lawyer, or at the very least, i type up every situation, take a copy over to his office, then he has something in black and white, over verbal.

of course i also (under a suggestion from a friend), recorded the message that Miss so and so left on my answering machine, for safe keeping. cuz if i know me, i will eventually erase the machine..no messages can be saved, as it is an old machine, one of the first digital recorders. i simply recorded it to my mini cassette recorder, that i used for taking mileage while on the road. had i had the old fashion cassette tape answering machines, well then, i would have saved that tape of course.

i personally do not know (unless i google search) how long it takes bones to fuse.

now, a broken bone may fuse faster, but in my situation, bone has to grow into an empty area. i'd surmise, that takes more time..??

in the end....

someone wanna play games...??

well...i ain't this old, and ain't learnt nothing........
 
Lawyer called me a few minutes ago.

he said that once the approval for p/t was given... IT CANNOT be revoked in any way.

when i called and left a message to his para-legal, somehow he was under the impression that it was revoked from me.

i said no, what i had said in my message was that i was told NOT to go until i have the assessment...

lawyer said, go....you are clear.


good news... for me.

when you do as told by the monkeys in charge, you can never be blamed for any wrong doing....(or so one would hope/think).

ah yes.....let the games begin....this old man is ready to rumble.....or fart...which ever is easier and less messy......:icon_dance:
 
pro1driver said:
Lawyer called me a few minutes ago.

he said that once the approval for p/t was given... IT CANNOT be revoked in any way.

when i called and left a message to his para-legal, somehow he was under the impression that it was revoked from me.

i said no, what i had said in my message was that i was told NOT to go until i have the assessment...

lawyer said, go....you are clear.


good news... for me.

when you do as told by the monkeys in charge, you can never be blamed for any wrong doing....(or so one would hope/think).

ah yes.....let the games begin....this old man is ready to rumble.....or fart...which ever is easier and less messy......:icon_dance:
Click to expand...

I know a coworker who was set for a fusion surgery. He got a Pre-op, arrived at the hospital, was sitting in his room waiting for IV fluids to be put in his hand when they pulled the rug from under him. Work comp denied the surgery. Not sure why they even authorized it in the first place but it must have been a huge misunderstanding.
Turns out he needed to follow the baby steps that progress to fusion surgery and he was only at Epidural injection shot #1. He still needed another shot with the next step being a Micro-discectomy. Fusion being the last resort. He was upset, the attorney was upset, it was surprising scenario but work comp was able to pull him off the surgery list for that day.
Everyone knows he needs surgery but he has to go through the baby step progression when it deals with work comp. He is currently going through the baby steps.

I agree, follow their directions don't deviate too much. Just keep documenting things like you've been doing, making sure your paper trail is legible and covers what's happening and you will never be accused of malingering.
 
Dockworker said:
I know a coworker who was set for a fusion surgery. He got a Pre-op, arrived at the hospital, was sitting in his room waiting for IV fluids to be put in his hand when they pulled the rug from under him. Work comp denied the surgery. Not sure why they even authorized it in the first place but it must have been a huge misunderstanding.
Turns out he needed to follow the baby steps that progress to fusion surgery and he was only at Epidural injection shot #1. He still needed another shot with the next step being a Micro-discectomy. Fusion being the last resort. He was upset, the attorney was upset, it was surprising scenario but work comp was able to pull him off the surgery list for that day.
Everyone knows he needs surgery but he has to go through the baby step progression when it deals with work comp. He is currently going through the baby steps.

I agree, follow their directions don't deviate too much. Just keep documenting things like you've been doing, making sure your paper trail is legible and covers what's happening and you will never be accused of malingering.
Click to expand...

this is wierd for sure..

the 'baby steps" i had to take was going to p/t right after the injury, like 3 days later...

ok now, when i spoke to the surgeon's nurse yesterday, she said that the insurance doctor said, i had already had 16 weeks of therapy, why does he still need more...???

i told the nurse, no, i have not had 16 weeks of therapy....


i HAD 8 weeks BEFORE the surgery which amounted to playing with myself as nothing got better...


then i said....i had 5 weeks of p/t.....AFTER the surgery....where does HE come up with 16....???

as long as your friend is doing as they say to do, he gets to collect worker's comp checks, so i say to him as well...milk it.....

they wanna run the show..???

fine, do as they say, get the money and laugh at them, in between the pain and sufferings.....

only, and i say only from what my lawyer told me, the therapy was approved (i knew that) and it cannot be revoked.

now, whether or not MORE will be approved, if after this round i show no improvements, i cannot say.

i do know of course only the Dr can discharge me from care, to go back to work, not the insurance company nor the p/t place.

but then again...5 people now, 4 p/t's and the doctors nurse have all said, "you might not be able to return to your job"...

if this turns out to be true, then again, the lawyer takes this and runs with it.

do i have to go back to school at my age, and learn something new, and start from the bottom again...???

and what are my chances of a job at my age..???

either way, if the insurance company wants to get rid of me and the costs involved, someone has to pay for it..

i was doing my job, got hurt.....

not knowing your friends whole story, he could very well be in the "same boat" as me, and God only knows how many others.....
 
Lack of communication again.
Usually PT happens long before and/slightly after a medical procedure. They shouldn't be adding the total you have received before and after, that's just plain stupid on their part.
They usually have a prescribed/allotted amount of therapy they authorize for each procedure.

Like I said somewhere in these thousands of replies. LOL. It's a hurry up and wait with work comp. You are at their mercy of approvals so take a sit back and wait approach.
If you get antsy knowing something is pending approval and taking too long, you can call your doctor or lawyer but most people just sit it out and wait.

Doctor can discharge you sooner or late, but if work comp feels there is some malingering going on (Because of late discharge), they can order an IME on you. In fact they will order an IME on you at a later date. I'm sure you know what an IME doctor does and basically who's side he is really on. (hint: you are observed the moment they lay eyes on you and while you wait)
If you are on the road to coming back to work, there might even be an FCE performed on you. (hint again: you are observed the moment they lay eyes on you and while you wait)
It's whole lot of mind games and physical ability testing being played on you to find out if you are road ready strength wise, malingering, pretending, stalling, etc.

It sucks the deck is getting stacked against you as far as ever returning to work. It's hard not to be don't let it get you down, just stay focused on your healing. You can tackle that part at a later date. Sometimes it's a good feeling that job change is coming. I'm sure your lawyer will fill you in on the vocational retraining if it comes down to it.
 
IME and FCE..

i had to look up those letters, as they meant nothing at first...

i still have problems with "alphabet soups".....
 
A really serious update.......!!!

ok, got a call from the p/t place...

gal says my p/t which was supposed to start tomorrow (Friday Sept. 26th)

HAS BEEN REVOKED.....~~~!!!!~~~


she said she got a letter in today's mail, and it was "bcc" to the lawyer..

i called the lawyer's office, the para-legal was talking to me, while the lawyer was screaming on the phone at the insurance company, and he will call me back ASAP after he hangs up with them..

that was all of about 15 minutes ago.....

must be some phone conversation right about now.....

my claim is a RI claim, even though i was hurt in MASS.

i get paid ALL wages, benefits, taxes, disability, every thing, everything is RI paid...

the insurance company "accepted the claim responsibility" that made it a RI claim.....MONTHS AGO.....!!!

in fact, i was supposed to go to workman's comp court, to "testify" about this, but at the 11th hour, insurance company "caved in" and accepted responsibility.

if this were a MASS claim, THEN they can do this, as i was just told by the para-legal, go thru reassessment, etc,etc....

so why this BS...???

That Align Networks i was just told, is a "payment company for the insurance company" and the place THE DOCTOR wants me to go to, is not in thier network, so here comes all the BS,

i have THE LEGAL RIGHT, to go where I WANT TO GO, and no matter network or not...they have to pay....

hey, you know what..??

no matter what.....the insurance company HAS TO CONTINUE to send me weekly compensation checks, until the DOCTOR DISCHARGES ME......

and if that'll be 1 year or "up to" the 6th year (In RI, one can be on comp for 6 years)..then the insurance company has to keep paying me.....

as i said in an earlier posting....

"let the games begin" (they already have though).....

"GAME ON".......!!!!!!!!!

i'll update as i get the information.....
 
Too many hands in the pot and lack of communication! OMG...Take a sit back and watch approach now.
You'll end up with severe migraines if you don't already have them while trying to keep up with them.

As far as I now you have the right to go where ever you want in network or not.
They do try to steer you to their in network places to lower their costs. Most people that are new to this rodeo usually follow their advice and go, they feel they owe it to their jobs for taking care of them. (He he)
Others think there is some underlying scheme with their work place and work comp in the possibility of screwing them over, people who have gone through this know you can go to who you want and feel more in control and comfortable that way. At least in my state.
It's ashamed you got the rug pulled from under you too. Sorry but It's sad you have to go through this but kind of comical with how it's going.



IME = Independent Medical Examination
FCE= Functional Capacity Evaluation/Examination
 
Dockworker said:
Too many hands in the pot and lack of communication! OMG...Take a sit back and watch approach now.
You'll end up with severe migraines if you don't already have them while trying to keep up with them.

As far as I now you have the right to go where ever you want in network or not.
They do try to steer you to their in network places to lower their costs. Most people that are new to this rodeo usually follow their advice and go, they feel they owe it to their jobs for taking care of them. (He he)
Others think there is some underlying scheme with their work place and work comp in the possibility of screwing them over, people who have gone through this know you can go to who you want and feel more in control and comfortable that way. At least in my state.
It's ashamed you got the rug pulled from under you too. Sorry but It's sad you have to go through this but kind of comical with how it's going.



IME = Independent Medical Examination
FCE= Functional Capacity Evaluation/Examination
Click to expand...



first....lawyer got back to me.

he was pissed off that this happened like it did, and the adjuster was not there (as claimed by her supervisor), so lawyer unloaded on him.

lawyer or his para-legal has to call back tomorrow morning.

so ok...instead of getting up at 4:00 my usual time, and get ready to go to therapy...for that 10 AM appointment...

i'll get to sleep late, till 4:30 AM, and have a sit down breakfast, maybe even have that downstairs with dad.

then i'll go outside, smoke a cigar, and have my eyes "peeled" for a camera crew trying to take my picture(s)......

then i'll go online for a while and get my post count up even more, "like" some posts from others.


comical...??

sure is, i am laughing each week that check comes in the mail.


yes, my state, your state law (and maybe all 50 states, but i do not know) say you or i can go where ever we want to go, and the insurance has to pay........

many people DO go to where the insurance company TELLS them to go, but i too whole heartedly feel that when one goes to where the insurance company says, you are under thier control, at all times...

now however, if that means they will wipe my ass after i take a dump, and maybe lick it clean afterwards, then hey....maybe i ought to go to where they say.....

but as long as i can still breathe and think on my own, and wipe my own ass....(and have a good lawyer that'll fight for me and MY rights)


i will go where i want to go.

more on this as time comes.
 
Update

just got a call from the therapy place..gal there, just got a call from insurance company.

gal at insurance company said to ignore letter stating therapy was revoked...

i go this morning at 10:30.. for an evaluation..


now i have to call lawyer's office leave a message , or speak with the para-legal about this....


anyone got some good headache meds...???
 
pro1driver said:
just got a call from the therapy place..gal there, just got a call from insurance company.

gal at insurance company said to ignore letter stating therapy was revoked...

i go this morning at 10:30.. for an evaluation..


now i have to call lawyer's office leave a message , or speak with the para-legal about this....


anyone got some good headache meds...???
Click to expand...

See? It's totally Comical. Keystone Cops comical.
If it was a personal medical injury, your treatment would have been speedier.

Okay...I'm going to come clean. I am the one puling the strings with your situation. I denied your physical therapy just to make a point and just to mess with you.
I also feed your attorney conflicting information and mess with align network. I told them you were back to work full duty no restrictions and than a day later told them you need therapy. I made them make you wear a bone stimulator. I pay your doctors, lawyer, nurse case manager good money to confuse you and make you say "Screw it, I want to go back to work!" ....Now how is that for needing headache meds?
I told you you're going to get possible migraines from this.
LOL...seriously. Although each situation is different, the delays, lack of communication and treatment steps pretty much follow the same protocol. You can almost tell what's going to happen next.
 
thanks..

i just minutes ago got back from the therapy session.

it was mostly an evaluation, measuring this, measuring that, pulling this, yanking on that...

no.....don't you DARE say that.........

pretty gal, in her 3rd year of her degree, soon to graduate, long RED hair, freckles, i never looked at her eyes...dammit.....i was too concerned about all that pulling and yanking.......

and don't you DARE say it......!~!!!!!
 
pro1driver said:
thanks..

i just minutes ago got back from the therapy session.

it was mostly an evaluation, measuring this, measuring that, pulling this, yanking on that...

no.....don't you DARE say that.........

pretty gal, in her 3rd year of her degree, soon to graduate, long RED hair, freckles, i never looked at her eyes...dammit.....i was too concerned about all that pulling and yanking.......

and don't you DARE say it......!~!!!!!
Click to expand...

We all now you're talking about some bony structure that's been fused to stay straight and hard at all times and not likely to bend. That's why there was measuring, pulling and yanking going on.

Drum roll please......and the climactic result is?
 
Dockworker said:
We all now you're talking about some bony structure that's been fused to stay straight and hard at all times and not likely to bend. That's why there was measuring, pulling and yanking going on.

Drum roll please......and the climactic result is?
Click to expand...




old-faithful-o.gif
 
you ain't lying either...

that room WAS small......!!

i could not believe the smallness of the therapy room, next to it, the pool room.

pool was 4 foot deep, and i'd say about 25 feet long..?? by about 8 feet wide..??

therapy room looked like it was about 30 x 30

but i didn't take a tape measure.....on this visit.
 
Update

had my "assessment" appointment at the surgeon's office this afternoon.

the doctor's p/a spoke with me.

i told him of the ongoing pain, at about a 5, and the sudden numbness of my right leg, and how sometimes it flops like a fish out of water...

he says it 'could be" from scar tissue on the nerves, and that can take well over a year to go away.

i told him about the insurance company "Richard Head" quack doctor stopping my therapy before i even got to go to this new place, as the old therapy place discharged me as i was not making any progress.

i told him how that "Richard Head" quack doctor told the new therapy place, as well as my lawyer, that i already HAD 16 weeks of therapy, and how WRONG HE WAS..

i told the p/a that i have ONLY HAD 4 weeks of therapy POST OP........

that the "Richard Head" insurance quack doctor is including ALL the therapy i have had since day one of the injury, and that's not how it's done...

the POST-OP therapy is what counts towards my recovery....

p/a agreed...it's what is POST-OP that counts.

the pre-op is to see if it is just a sprain, strain etc.


so the p/a said he wanted me to keep going to the new therapy place, and wrote up his assessment saying so.

on my way home, i dropped that letter/assessment off at the lawyers office, and he can fax it to quack doctor "Richard Head"......

or hold onto it till it's needed later, when MORE therapy will be needed......

like i said, i "can play too"......

who was the quack doctor at the insurance company really hurting anyway..??

me....???


i think not........

the insurance company has to keep paying me till my doctor discharges me........


so stall me all you want, quack.......

i laugh each time i go to the bank, and make that deposit.......!!!!!

ah yeah......let me see.......keep playing games......lawyer is tracking all of this crap.......

i hope that if the stalling/BS continues, and messes up my recovery, it will make for a nice settlement......
 
Quickie update

still doing the physical therapy, twice each week. i do a little bit at home as well.

still using the bone growth stimulator each day.

still in pain...that has not changed.

i have one more p/t appointment this week, then next week, an evaluation, and the nurse case manager called me today to say that the p/t place had already ordered up more p/t days.

as long as i have met "some of" the goals they set for me.

if i have not met the goals the p/t place set on me, then the nurse said she will do what is possible to get me back there, or at another place.

still do not sleep thru the night, and with the "other problem" i have now, that requires a procedure on the 24th, sleeping is a chore, as i spend a lot more time going to the bathroom.

that's about it for now...
 
pro1driver said:
still doing the physical therapy, twice each week. i do a little bit at home as well.

still using the bone growth stimulator each day.

still in pain...that has not changed.

i have one more p/t appointment this week, then next week, an evaluation, and the nurse case manager called me today to say that the p/t place had already ordered up more p/t days.

as long as i have met "some of" the goals they set for me.

if i have not met the goals the p/t place set on me, then the nurse said she will do what is possible to get me back there, or at another place.

still do not sleep thru the night, and with the "other problem" i have now, that requires a procedure on the 24th, sleeping is a chore, as i spend a lot more time going to the bathroom.

that's about it for now...
Click to expand...

You totally have to do your homework in order to heal at a good pace. (PT Homework, stretches etc.) It's easy to grab the paperwork with the stretches on it but it's harder to actually do them at home. We tend to get a bit lazy. So force yourself to do some of them even if you laying in bed.

Stay on a well timed medication intervals to keep the pain at bay and from creeping up on you.

Have you tried a sleep medication to help you get some sleep? I know some spine doctors prescribe Ambien or equivalent.
Most over the counter sleep medication like Tylenol PM, Advil PM etc don't work and are usually a form of Benadryl/Diphenhydramine HCl

The Unisom with the Doxylamine Succinate, seems to work. It doesn't give you that morning hangover you get from the PM's.

With any sleep medication, if you fight the sleep effects and do not go to sleep, it will no longer work and you will have the worst time trying to sleep.

Do you have any evidence that the Bone Stimulator is working? X-rays?
 
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