Frustrated, in pain, running out of options.

[firemedix911]

Thank you guys for replying and the positive thoughts.
So here is the deal with my WC and why lots of Docs won't take our WC. I work for the biggest fire department in the Southeastern US which is also part of the whole Metropolitan Dade County so we are self insured(boomer) well as luck has it last year around may our WC changed to a different program. Now they are behind in paying their bills bc of the whole conversion. Since they haven't paid basically most of the Docs since May 2012 most of them either ask for pre-payment or simply avoid my department at all costs. Lucky me right? This is the explanation I got from my case manager. I begged her and cried on the phone with her to please do anything within her power to help me reach an agreement with the Dr's office so I can be seen. She has apparently contacted the office manager for Dr Garcia and is trying to get an agreement of some type bc they keep saying they will absolutely not pre-pay(this suck). Truth is I'm not very optimistic at all. Regardless I have to just sit and wait. Again thank you all.

[Maria]

I moved from CA to FL back in 7/2003. I had CA WC future medical benefits since the mid 80's so anything related to my low back was paid for by WC and no other insurance. Before I moved I made sure that I had some providers lined up to see me re Pain Management.

When I did move to FL and went to the PM's office they then said that they did not take out of state WC and I would have to "pre pay." My WC didn't want to deal with this so they wouldn't agree and I couldn't have afforded it anyway after buying a home in FL right before moving there.

So then I tried 200 PM offices and no one would see me except for this one PM in Tampa who seemed to take everybody (like a mill) and he was the only person that would take my WC insurance. I saw him for over a year and then he wanted me to switch from getting lumbar ESIs to facet blocks even tho I did well with ESIs and had no radiologic reason or evidence to be getting facet blocks.

My WC wouldn't approve it anyway so then he said I had the worse WC insurance and no one trusted out of state WC so if he didn't see me no one would.

Right around then my husband got a job back in CA and we sold the house and moved and I was ever so glad!

So even back then offices were asking for pre pay tho I guess it had to do with not trusting they'd get paid. My Nurse Case Manager back then assured the offices they'd get paid and at a higher rate (CA WC rate of reimbursement vs. FL) but it was "no deal."

Out of state there is Dr.Bitan in NY I believe and CA has many surgeons that do ADR tho first you'd have to see if your WC will pay for you to be seen out of state and if the surgeons take out of state WC or WC at all.

I wish you the very best and thank you as well for what you do for a living! It's weird tho I don't understand not wanting to help people that are in helping professions to get better and fighting over $$$ and then ending up using up more WC $$ just fighting us to get better and have our lives and professions back. Makes little sense to me...

[firemedix911]

Originally Posted by Maria

I moved from CA to FL back in 7/2003. I had CA WC future medical benefits since the mid 80's so anything related to my low back was paid for by WC and no other insurance. Before I moved I made sure that I had some providers lined up to see me re Pain Management.

When I did move to FL and went to the PM's office they then said that they did not take out of state WC and I would have to "pre pay." My WC didn't want to deal with this so they wouldn't agree and I couldn't have afforded it anyway after buying a home in FL right before moving there.

So then I tried 200 PM offices and no one would see me except for this one PM in Tampa who seemed to take everybody (like a mill) and he was the only person that would take my WC insurance. I saw him for over a year and then he wanted me to switch from getting lumbar ESIs to facet blocks even tho I did well with ESIs and had no radiologic reason or evidence to be getting facet blocks.

My WC wouldn't approve it anyway so then he said I had the worse WC insurance and no one trusted out of state WC so if he didn't see me no one would.

Right around then my husband got a job back in CA and we sold the house and moved and I was ever so glad!

So even back then offices were asking for pre pay tho I guess it had to do with not trusting they'd get paid. My Nurse Case Manager back then assured the offices they'd get paid and at a higher rate (CA WC rate of reimbursement vs. FL) but it was "no deal."

Out of state there is Dr.Bitan in NY I believe and CA has many surgeons that do ADR tho first you'd have to see if your WC will pay for you to be seen out of state and if the surgeons take out of state WC or WC at all.

I wish you the very best and thank you as well for what you do for a living! It's weird tho I don't understand not wanting to help people that are in helping professions to get better and fighting over $$$ and then ending up using up more WC $$ just fighting us to get better and have our lives and professions back. Makes little sense to me...

Maria your point is well taken. Let me let you in on a little secret. When you work for local government for a bit the first thing you realize is that whatever makes sense to most people they won't do it and it's not design to facilitate anything. Why you may ask? I don't have an absolute answer. I'm sure that corruption among other things is a factor as well as bureaucracy. Bottom line is something so important gets really complicated and none of the people that could help understand you for the most part. So you have to suffer and fight and then you discover how senseless and egoistic human beings can be.(I'll take my cats and my dogs every day) Anyways I could go on with the rant but I don't wanna bore you. LOL!!!

Again thanks far all the replies. It's been helpful.

[jsewell]

I am so sorry that WC is such a mess. Especially yours not paying providers for several months. It is also hard to fight when you are in pain. I had to fight with Aetna for surgery to fix my broken neck. I couldn't lift my head up for months waiting for the idiots to approve the surgery. It was clearly broken on the x-ray. At the present time i am again in a fight for a medication since last July. It is a big boring mess at this time.
I used to run to deal with great frustration like this , but my hip replacement made sure that is not an option.
I feel for you and being so young and basically i think your hands are tied. I don't know anything about WC could there possibly be some little rule that would make things in your favor? I am just hoping.
Good Luck and let us know if things change or just come on to rant , i sure do.
judy