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  1. #1
    jaxlady Guest

    Default Medical Case Managers At Doctor's Appointments

    Like lots of other IW's, my husband has health problems in addition to his work-related injury. Recently the IC assigned a medical case manager. On a form she gave us, she states she'll be attending medical appts with my husband. Am I wrong to assume that it's OUR choice, NOT hers, whether she can attend doctor's appts with us?

    We just found out my husband must have surgery (not related to the work injury). Our attorney says we need to inform the NCM---but does that mean she will be attending THOSE appts also??? And any other medical appts not connected to WC??? This is all very confusing. We feel like we're living in a fishbowl.

    We have a call in to the attorney. In the meantime, any info from IW's would be appreciated.

  2. #2
    dennison Guest


    jaxlady, when your husband goes to a dr's appointment WC related or not it is up to him if he wants anyone in the room or not, it is called PATIENT"S RIGHT to PRIVACY.
    Also involved in all of this is the new HIPPA LAW
    IC's want someone their to intimidate, they can get the report later, SORRY. Always remember you as a patient do have RIGHTS.

  3. #3
    hodcarrier Guest


    greetings, Jaxlady, I was in a severe work accident, and have been to many, many, Dr. appointments. I have had seven different Drs. each treating a different body part, I felt like a frog in science class, many multiple dr visits, me and my wife did not have a clue, when this all became our world, we had to learn alot, and as for the nurse, she will not be attending any dr. appointment, that is not related to your husbands WORK injury, she will be at his Work related injury dr. appointments. AGAIN, that does not mean she is allowed in the exam room, leave here in the waiting room, what happened at all of my appointments is first i would see the dr. then after we were done, the dr. would come out and talk to the nurse and tell her what was going on. she would try to take control sometimes and pressure drs. to do things to the insurance co.s advantege, such as trying to press them into releasing me to early, but when i would see her trying to pull stunts, i would jump her case and tell her to back off, then she would just be more sneaky about it, they are snakes, point blank. but you just have to learn how to deal with them, they will be there trying to reach out and affect your husbands dr. any way they can.

  4. #4
    pt Guest


    Had a couple of telephone conversations with Miss know it all, who didn't know a whole lot - then asked that my Attorney deal with her. To my knowledge, I've never been in the same room with her.

    Doc, corrects her comments and "creative writings" - then we...kinda laugh. Don't guess that she likes either of us too well.

    Too bad - but time will tell - Always does !

  5. #5
    edk Guest


    Hod is right, you do have the say whether she is in with your husband when he sees the Dr.

    It baffles me that there are those so pushy as to try and enter the exam room, thank the Lord mine never they would have had a fight on their hands.

    One thing I have noticed through the years of many moves with my husbands jobs. when you get an adjuster who is unreasonalbe in his/her demands and unwilling to let you speak to a superior.....go over their heads. Hit their web site and start sending your story to every email you can find. We just encountered an A-hole adjuster on our last move. the most pompous jack a s s that I ever met. I finally did a search for the comapny site and started sending emails to everyone. Our problem was taken care of within a week.............after 5 mos of dealing with this p rick named Dick (how appropriate don't you think?) I can not say that this works for every situation but why not try?

  6. #6
    aj Guest


    There are 2 issues her. The first is the unrelated medical care. No the nurse has not legal right to attend any of those appointments without your authorization. With the recent HIPPA laws she cannot even obtain the records from those visits without your signed authoiration. The second is the wc claim. While youc an refuse to allow her in the examining room with you at the time of the appointment she does have the right to meet with the doctor and discuss the medical care. She can even do this at a separate time from your appointment without you even being there. The carrier has the right to the medical records in this regard. Of course the iw also has the right to see the medical and any correspondence the nurse or carrier sends to the doctors along with the responses. In Florida HIPPA does not apply to wc claims.

  7. #7
    jaxlady Guest


    Thanks for all your input. Still waiting for a definitive answer from the attorney.
    I'm inclined to think that the NCM has no business being informed of nor involved in ANY medical appt that doesn't pertain directly to his injuries. Our attorney may disagree, but that doesn't mean we have to follow her instructions to the letter, only listen to her advice. Something seems terribly wrong when/if a rep of the IC can horn in on an IW's private medical concerns that have nothing to do with his/her injury. And I will be very surprised if that's the case. (we won't be signing consent for her to view any medical records that don't pertain to the work injury either)
    We can't stop her from meeting with the doc before or after an appt or from obtaining records pertaining to the injury from the treating doc or the IME, as we have signed releases for her to do so. Furthermore, we'll be playing ice hockey in H E L L before she steps foot in an exam room with my husband.
    We got a letter from her today stating she needs to meet with my husband to discuss his treatment plan. Unless she's willing to meet with us after hours or on the weekend, she can forget that. He won't be meeting with her without me and/or the attorney present. She won't be 'visiting' us at home either, unless the above conditions are met. I just don't trust her, or anyone else from the IC.
    I'm well aware of the HIPPA laws, as I work in a mental health center.
    Thanks again everyone. Will keep you apprised of the situation.

  8. #8
    dennison Guest


    good for you JAXLADY, believe me IC's hate it when people are aware of the new HIPPA rules and believe me when you throw it in their face they go running. GOOD LUCK

  9. #9
    hodcarrier Guest


    to me, the only reason your husbands lawyer would even suggest allowing a ncm to attend a dr. appointment that is not related to the work injury, would be because, they feel, or plan to connect it to the injury, otherwise, there would be no reason, you were not clear, when you commented on whether or not your lawyer approved of the ncm being there, I no like in my case, I have medical problems not related to my work injury, such as high blood pressure, (witch, i never had before my accident.) that I feel is a result of my injury after-affects. but is not treated by work- comp insurance co.- as of now, but court day, I sure am gonna fight that fact, anyway, did the nurse mention attending these non-work injury dr. visits? or are you just like me, wonder and worry, about so much we are not aware of? Just curious, and if you would rather not say, i very well respect that, but how will your husbands non work related illness affect his work related injury? will any of the above affect his return to work capabilities? work comp only pays for work injuries, ssa takes everything into account. has he applied for ssa? does he need to? just wondering.

  10. #10
    jaxlady Guest


    Hmmm-don't know how our attorney could possibly connect the need for gallbladder surgery to his work injury.....and unless there are complications, this type of surgery would have no impact on his ability to return to work. It's the back injury & delay in proper treatment that will delay his return to work!

    The NCM hasn't mentioned much as we don't talk to her. She showed up at the IME, but said very little to us. She did complain that our attorney had phoned her & told her she would not be present in the exam room. Maybe that cooled her jets somewhat.

    He's still on TTD (not at MMI) so we haven't applied for SSA & won't til the whole WC thing is over, unless something changes drastically.

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