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  1. #1
    Join Date
    Aug 2009
    Location
    AZ
    Posts
    9

    Question Ncm and Doctor

    Hi-you have all been very helpful in the past-I thank you

    A NCM left a message informing me of an appointment she made with my doctor for me next week, I have not met her nor did I know I was assigned one. My next appointment was not until Dec. My question-does she go into the examining room with me, do I have to let her, is this the law? I am in AZ. I do not have an attorney yet, however will look for one soon.

    My last appointment I decided to put off surgery (back) until I lose 70 pounds, doctor agrees this is a good idea and pain might be more manageable if I do, as well as surgery would be more safe.. So this butterball just keeps on trying with the help of percocet.

    Thanks for any help and have a wonderful weekend.

    From Use to Golf-a-lots

  2. #2
    Join Date
    Oct 2006
    Posts
    9,073

    Default Re: Ncm and Doctor

    it's your choice. some have a separate private visit with your doctors; others will do it with you present.
    you may want to complete your exam first before inviting them in to discuss treatment plans with the doctor.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,938

    Default Re: Ncm and Doctor

    You don't have to permit the NCM in the exam room with you. You should not allow the NCM to discuss your claim/treatment plan with your doctor with out you present. The NCM has a right to discuss your injury, diagnosis and treatment plan, cuz they are paying the bills.
    You have no rights under HIPAA with a comp claim.
    Generally, this health information is obtained from health care providers who treat these individuals and who may be covered by the Privacy Rule. The Privacy Rule recognizes the legitimate need of insurers and other entities involved in the workers’ compensation systems to have access to individuals’ health information as authorized by State or other law.http://www.hhs.gov/ocr/privacy/hipaa...rkerscomp.html
    Usually the carrier wants you to be seen by your treating physican at least monthly/6week interval, you need to to certify your continuing need for treatment and other benefits.

    If your doctor is requesting a weight loss prior to surgery, that can be a compensable consequence... meaning the carrier will pay for a weight loss program to expediate, and monitor your weight loss program. They do this to protect you and their best interests, and of course to minimize the number of weeks you will be paid wage loss benefits. Losing 70# on your own could take a year or more. A monitored program could take much less, and be better for you in the long run.

  4. #4
    Join Date
    Aug 2009
    Location
    AZ
    Posts
    9

    Default Re: Weight Loss-back pain-surgery

    Thanks so much again-I live out of town (40:00) so getting to a gym is a real problem-I want to buy a recumbent bike but cannot afford one right now, its one exercise that does not hurt me much.

    What type of weight loss do you think WC might take care of, I think I am too old for any surgery (65). Yes on my own it will take quite a-while. I just lost 12 pounds but it took 3 months!!

    Then what happens so I lose the weight-have surgery and still have the problem? My surgeon said he is about 70%-80% successful but I might still have some pain. Won't WC be upset if they pay for me to lose weight but after still have the pain? Doctors findings are lumbar spondylosis and stenosis exacerbated by a bad fall. I have lots of pain, maybe if I lose weight it will all go AWAY!

    Hope I am making sense????????
    used to GOLFALOTS

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,938

    Default Re: Ncm and Doctor

    Won't WC be upset if they pay for me to lose weight but after still have the pain? Doctors findings are lumbar spondylosis and stenosis exacerbated by a bad fall. I have lots of pain, maybe if I lose weight it will all go AWAY!
    IF your doctor can provide medical reasoning that a weight loss program is necessary prior to performing any surgery on you, then the IC can be liable for a medical program...not necessarily surgery, but a monitored dietary program. And not Jenny Craig, or another TV ad ... and your doctor can write a Rx for treatmill, or bike that he sees fit to assist with your goals of weight loss.

    Don't worry about the IC being ''upset'', that isn't relative.
    The goal of medical treatment in WC is different that a personal injury claim... PI would strive to return you to pre injuiry condition. Not WC.
    Comp treatment is geared to functional restoration, and gainful employment. Whether that is pre injury employment/employer or not, doesn't matter.
    There a 1000's of people going to work every day in 'pain', and lots of those are taking medication for pain management.
    Once your treatment is complete to a stable condition/MMI. You could be referred to a pain management doctor to learn the ways to control/manage and live with the residual pain you may suffer.

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