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  1. #1
    tlc Guest

    Default Getting a Second Opinion

    Hi everyone, I went to get a second oppinion after I had surgery, I was shocked to find that the wc doctor did not fix the tear he said he fixed and the clavical he clamied he gave me on a clavical resection is now detorating...so I was upset I had to talk to my laywer and then stop the wc benefits, I was not letting thier doctors touch me again, I am now lopsided on one side, I am going to trial over this! I am upset hurt and my life I simply want it back, That wc dr, didn't even blink when I told him I was in pain still, he ignored me! I got my secod oppinion and he said the rotator cuff is torn! what did wc doctor do?
    I am glad I have insurance and we go to surgery soon!!!!
    I just want everyone to know try to get a second oppinion before this happens to you!
    My laywer said wc won't pay for the surgery I need done, I SAID FINE SEE THEN IN COURT THEN!
    I feel that don't care about you at all!

  2. #2
    pooh Guest

    Default

    TLC

    I must also remind ppl that many states offer a change of doctors. Normally an attorney is familar with this procedure - so they should always check with their attorneys on this. In many cases the health insurance won't pick up the cost of surgery or treatment for a wc injury without a clear denial from the IC.

    As with any medical treatment - if you feel the doctor is giving you a run-around - then you should ask for a 2nd opinion and in some cases WC will give you that option. Note your own state laws on that - some states the employer still gets to choose the 2nd opinion doctor while in other the employee is able to choose thier 2nd opinion doctor.

    I wish you luck on your surgery - has it been scheduled yet?

  3. #3
    aj Guest

    Default

    You are taking a gamle without having authorization for the surgery from your carrier. Has you health insurance company agreed to pay for the surgery? In most states the carrier does not have to pay for unauthorized medical care unless it is considered emergency medical care. You need to ask your attorney about your rights to a second opinion or change in physicians. Without authorization from either the wc or group health sice you could be exposed to a large amount of medical bills. If you have asked for a change and they denied this then some states will allow you to seek medical care with a doctor of your choice and then bill the carrier. Does seem as though that is your situation though.

  4. #4
    iw Guest

    Default

    You might have re-injured the rotator cuff yourself. If a Dr., the insurance carrier, and even your own lawyer who isn't fighting it now can't support the surgical claim that you are making, than you might just be spinning your wheels and could seriously be out of luck. Could be that your lawyer and the Dr. seen film or obtained other evidence that won't support your accusation.

    It can really help an IW to at least try to look at the entire picture.

    Good luck.

  5. #5
    tlc Guest

    Default

    I didn't injure the rotator cuff myself I haven't done anything to do as such, I have been doing a whole lot of anything, I have been to other doctors for wc but as for them to do the rotator cuff is a partial replacement and the wc will not pay for that per my attorney, so I have no choice if I let it go then that means my shoulder will be messed up, My lawyer says for doctor change because we are going to trial I don't have to do that because there was a tear fornd from the beginging and they wc sent me doctors until they said no tear, pretty unbelievable but true, I have the first mri and a recent one and otheres, the wc doctor that worked on me did not do the surgery right my clavical is now disingrating the bone, I have been through this a year and 3 months wc doctor also did not give me pain meds or did he look at me to see how I was healing all he said standing at the door lift your arm which I couldn't and he said back to work you go!
    I did what he wanted when work didn't put me back to work he gave 4 times a week PT and I was in pain I kept saying that and nothing was done, after pleading the wc said I am not doing another surgery I had no choice to get that second oppinion, so I talked to my lawyer and got my second oppinion and was shocked to find out the tear had still been there!
    I have pleaded to get a doctor change and they won't let up, so my next step is court!
    My ins. co is paying for this and my lawyer will get the bills and i guess to court we go! I don't want to do anything wrong but then a judge can say why didn't you get a second oppinion if I was in pain!
    well I can honestly say this has been the worst nightmare its time to get fixed! by real doctors that at least are not mean...rude, every appoinment I had witnesses from the start and they can vow that the wc docor said and did things that were horable!

  6. #6
    pooh Guest

    Default

    TLC

    in your case sounds like you were denied - that's why the insurance has picked it up so far. Then what will happen is the health insurance company will put a lein on the claim - normally cases like this is turned over to loss and prevention for the health insurance company.

    Aj and I were just forewarning that getting the 2nd opinion without going through proper channels then could lead to bigger problems with the health insurance also denying payment and the IW being stuck with the bill - that is why it is always best to get it pre-approved with health insurance prior to any s urgery (also some health insurance companies require pre-approval prior to scheduling).

    I know with my appointments - my doctors have called the IC to get the pre-approval since I using my health insurance/cobra policy. My health insurance company had also asked for a copy of the denial letter faxed to them from my attorney - this is on file so makes it easier to get treatment.

    I can tell ya this - the amount of money that my health insurance has paid out and what my co-pay has been over the past 18 months - total close to if not over $20K at this time. So you can imagine if I had to pay that all myself - that is a years salary for me roughly with take home pay (or should I say when I was working). And I still have not had surgery if I had - well the figure would be at least double that.

  7. #7
    tlc Guest

    Default

    oh great, well I hope all is well my IC is picking up the bill maybe I need to clarify with my lawyer when I tell him of the date of surgery...I felt I would rather use my ins. until this goes to trial I have a feeling it won't go to trial because they were well aware of what was going on, in the end they are gonna reimburse my ins.co, my lawyer will see to it!
    I know I won't be geting benefits from wc but I rather be fixed then to be jerked around again, if I never went to the second oppinion then I would have never known what was going on, I have been inpain and ignored and I feel that I finally got the answers of why, my doctor said he will stick up for me!
    I hope all goes well I am so confused anymore!
    My lawyer said its about health! my health!
    these wc ppl don't care! and I am so scarred to do the wrong thing but I need my arm as well!

  8. #8
    iw Guest

    Default

    Along with the possibility of any self-incriminating film, or witness statements, have any of the Dr's you've ever seen mentioned any lifestyle, or congenital (born with) defects that would cause and contribute to a medical deterioration to that particular area?

    In the long haul, and often in spite of what some might think - insurance carrier's aren't into wasting their potential for a profit. I'm not saying that their methods are always proper and good - just big time, successfully proven and business-smart.

    Has your private health insurance ever requested or obtained approval from your, or any other Dr.s finding for medically necessary surgery? If so, what was the outcome of that?

  9. #9
    pooh Guest

    Default

    IW

    In my case they have asked for doctor reports - health insurance - along with accident reports, etc from my attorney.

    They have asked my current neuro for additional information as to why he did an emg/ncs on the legs and the one shoulder (Only did one because all symptoms seem to be bi-lateral evenly - even with emg/ncs).

    The only thing I have had turned down was PT he ordered for TOS. (That is because I have good range of motion with a shoulder that is deteriorating - they determined not medical necessary to my understanding)

    As for meds or anything like that - no problem. Surgery - they know will be medically necessity when I have it. I have not pursued that since we are trying to figure out what all is going on at this time. It's a long drawn out thing considering I went 18 months with very little treatment and most doctors would not deal with the WC injury even though it had been denied. so that's another aspect some have to deal with - doctors not helpign those that have a contested case. - and mind you I was treated for 18 months prior to them saying it was pre-existing.

  10. #10
    tlc Guest

    Default

    well in my case I have not done anything no witness and as far as doctor statements well I have had witnesses in the room the entire time I have been hurt and no its not a exsisting diesese that I had never had one and my clavical was alot better till he did something to it, and MRI'S don't lie...that happened at work and I know it did and they do to, its a torn rotator cuff from lifting a 75 pd box which my clavical was jammed and a neck sprain.. which was not in my job description!

    I left this to my laywer and I think if he didn't have a case worth tryin he wouldn't take it,
    They can take whatever they like, I HAVE EVIDENCE to! They have nothing or they won't find anything I have been to hurt to do anything!!!!
    I am proud to say.
    I am in this for my health and not there's I want my own doctors and now more than ever I understand fully why they want you to go to thiers..a cover up!
    IW,I may not understand everything...but my family have been through to much, we tried wc,I was released back to work, so I am entitled to a second oppinion!
    I have everything to go to court, I am prepared very well! my health is so much more important than anything else!
    I think anyone in my shoes would agree!!!

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