Workers Comp and private insurance

[Maria]

When first injuring spine it was work related. Had private insurance from work as well. Was seen in ER at work that a.m. (worked in neurosurgery nights at the time of injury). Filed it as work related injury and because I could get nothing done back in the 80's with regard to injury/work status I filed a WC lawsuit and ended up not with the job but with a small settlement, voc rehab in the form of payment for MSN program that I had already started, and future medical benefits.

I have always used the WC benefits except for some testing and usually been notified that I needed to inform the insurance company of another insurance such as WC if I had it.

The last time I used private insurance for some osteopathic treatment on my low back I was advised by BCBS of Ma. that my claim was being investigated and asked to provide more information. I ignored the inquiries hoping the insurance company would lose interest in pursuing this but the inquiries became stronger and since it was my husband's insurance he was notified that the forms being sent out MUST BE filled out and returned.

Because I was seen with regard to total spine treatment with adjustment and complained of migraines (reason to be seen/treatment) as well as low back pain I was able to state this was not related to my back injury but rather treatment overall for my spine that just happened to include my low back as part of the adjustment. A very lame explanation but I wrote it, I had to repeat it over the phone to an adjustor, and it seemed to fly.

WC is a pain to deal with although fortunately I had my discograms authorized without any problem as well as MRIs (diagnostics) my first two surgeries and my 3rd proposed surgery when two level ADR trial was authorized then offer withdrawn, and several years later the recommendation became 2 level hybrid surgery which was also authorized with some time.

I will admit however that most of everything that was authorized more easily for me was before UR was involved in so much decision rendering as well as use of ACOEM guidelines and evidence based medical decisions in WC.

Seems like quite a bit gets denied these days that used to be authorized more readily (such as my 3 ESIs/year).

Good luck and tread carefully with this decision.

[racergaldar]

Originally Posted by Maria

When first injuring spine it was work related. Had private insurance from work as well. Was seen in ER at work that a.m. (worked in neurosurgery nights at the time of injury). Filed it as work related injury and because I could get nothing done back in the 80's with regard to injury/work status I filed a WC lawsuit and ended up not with the job but with a small settlement, voc rehab in the form of payment for MSN program that I had already started, and future medical benefits.

I have always used the WC benefits except for some testing and usually been notified that I needed to inform the insurance company of another insurance such as WC if I had it.

The last time I used private insurance for some osteopathic treatment on my low back I was advised by BCBS of Ma. that my claim was being investigated and asked to provide more information. I ignored the inquiries hoping the insurance company would lose interest in pursuing this but the inquiries became stronger and since it was my husband's insurance he was notified that the forms being sent out MUST BE filled out and returned.

Because I was seen with regard to total spine treatment with adjustment and complained of migraines (reason to be seen/treatment) as well as low back pain I was able to state this was not related to my back injury but rather treatment overall for my spine that just happened to include my low back as part of the adjustment. A very lame explanation but I wrote it, I had to repeat it over the phone to an adjustor, and it seemed to fly.

WC is a pain to deal with although fortunately I had my discograms authorized without any problem as well as MRIs (diagnostics) my first two surgeries and my 3rd proposed surgery when two level ADR trial was authorized then offer withdrawn, and several years later the recommendation became 2 level hybrid surgery which was also authorized with some time.

I will admit however that most of everything that was authorized more easily for me was before UR was involved in so much decision rendering as well as use of ACOEM guidelines and evidence based medical decisions in WC.

Seems like quite a bit gets denied these days that used to be authorized more readily (such as my 3 ESIs/year).

Good luck and tread carefully with this decision.

This is good to know. Especially because lately I've developed new pains in the foot and ankle. After some research, I learned that some foot/ankle pain can also be attributed to nerve damage. Initially, the pain was in the leg and lower back.