Can I still see the doctor?

[ChattiPatti]

What is the name of your state? Florida
The workmans comp insurance company has put my case on hold after they heard that I need a knee replacement. The doctor has said that he will not fill my prescriptions over the phone anymore.
What I want to know is that when I call the insurance company and tell them that I need to see the doctor, can they refuse this?
I had called the insurance company last week and asked if they were making a follow-up appt. for me. The nurse said she would look into this and that she would get back to me that same day. Well, she never did.
From what another person from the insurance company told me is that my attorney and their attorney are dealing with this.
What could this mean? I am still receiving my checks. Doctor has not released me.
My leg is getting no better.
Thanks for any advise.

 

[mlane58]

What is the name of your state? Florida
The workmans comp insurance company has put my case on hold after they heard that I need a knee replacement. The doctor has said that he will not fill my prescriptions over the phone anymore.
What I want to know is that when I call the insurance company and tell them that I need to see the doctor, can they refuse this?
I had called the insurance company last week and asked if they were making a follow-up appt. for me. The nurse said she would look into this and that she would get back to me that same day. Well, she never did.
From what another person from the insurance company told me is that my attorney and their attorney are dealing with this.
What could this mean? I am still receiving my checks. Doctor has not released me.
My leg is getting no better.
Thanks for any advise.

If you have an attorney, why are you contacting the carrier? Let your attorney run interference, thats what they get paid to do.

 

[ChattiPatti]

You are right. My attorney is on the case, but I thought I had to be the one to make the dr. appts.
One more question if you can maybe give me some insight.
I have never had a problem with my knee before this injury. I had a torn medial meniscus. Which when they did the MRI it showed my knee was bone on bone. The dr said the meniscus can not be repaired that I need total knee replacement.
This is when the insurance company cancelled my appt. with the surgeon and has said all is on hold. I think they are trying to refuse surgery.
my question is if when they go through all my medical records and see that I never had knee problems before and the doctor is saying that when I had this injury that is when all the pain started do you think that in the long run they will have to let me have this surgery?
hope I am making sense here.
Thanks for any response.

 

[weenor]

You are right. My attorney is on the case, but I thought I had to be the one to make the dr. appts.
One more question if you can maybe give me some insight.
I have never had a problem with my knee before this injury. I had a torn medial meniscus. Which when they did the MRI it showed my knee was bone on bone. The dr said the meniscus can not be repaired that I need total knee replacement.
This is when the insurance company cancelled my appt. with the surgeon and has said all is on hold. I think they are trying to refuse surgery.
my question is if when they go through all my medical records and see that I never had knee problems before and the doctor is saying that when I had this injury that is when all the pain started do you think that in the long run they will have to let me have this surgery?
hope I am making sense here.
Thanks for any response.

Just because you never had problems before the accident it does not mean that the need for the knee replacement is related to that accident. You could have a congenital condition that was aggravated by the accident and the insurer is going to make sure that your condition is work related before it agrees to pay. The insurance company is probably also questioning the need for the replacement and may be seeking another opinion. This actually a benefit to you because you don't need anyone cutting on you if it is not necessary.

 

[ChattiPatti]

I understand what you are saying.
I just want to know that if I need to go the doctor and have my prescriptions filled, can they deny that while they are deciding what to do with my case?

 

[BlondiePB]

I understand what you are saying.
I just want to know that if I need to go the doctor and have my prescriptions filled, can they deny that while they are deciding what to do with my case?

Make yourself an appointment with your w/c doctor. Once you are initially approved and your first appointment is made by the w/c carrier, you don't need them to make additional appointments to see the w/c doctor you have ALREADY been seeing.

 

[weenor]

Make yourself an appointment with your w/c doctor. Once you are initially approved and your first appointment is made by the w/c carrier, you don't need them to make additional appointments to see the w/c doctor you have ALREADY been seeing.

The doctor's office will likely not accept an appointment without prior w/c approval because they know they won't get paid. OP you need to contact your case manager and if you don't have one, contact the adjuster. In most cases they will continue to approve the medication prescribed by the doctor...DO NOT make the appointment on your own, because if for some reason the appointment is made without prior w/c approval and w/c doesn't pay, guess who will get stuck?

 

[BlondiePB]

The doctor's office will likely not accept an appointment without prior w/c approval because they know they won't get paid. OP you need to contact your case manager and if you don't have one, contact the adjuster. In most cases they will continue to approve the medication prescribed by the doctor...DO NOT make the appointment on your own, because if for some reason the appointment is made without prior w/c approval and w/c doesn't pay, guess who will get stuck?

In FL, once the w/c PCP or last treating specialist gives an MMI and there is no settlement, the injured worker can still make appointments with that physician who the injured has been seeing and there should be a very small fee, if one is charged at all tho the injured worker. When an injured worker is not seen by a w/c physician for a year (last I looked it was a year), the w/c carrier can begin to close the case, which is another tatic used by the carriers for delaying things. I've had the unfortunate experience of dealing with w/c crap in FL. But, I did find an excellent attorney who I thank every time I read some of these settlements here in this section.

 

[weenor]

In FL, once the w/c PCP or last treating specialist gives an MMI and there is no settlement,

This poster is not at MMI

the injured worker can still make appointments with that physician who the injured has been seeing and there should be a very small fee, if one is charged at all tho the injured worker.

Op has not been released from treatment- she really needs to hound her lawyer to get this set up through the insurance company and find out what they are doing now. If she doesn't have a lawyer then she needs to contact them herself.

When an injured worker is not seen by a w/c physician for a year (last I looked it was a year), the w/c carrier can begin to close the case, which is another tatic used by the carriers for delaying things.
I've had the unfortunate experience of dealing with w/c crap in FL. But, I did find an excellent attorney who I thank every time I read some of these settlements here in this section.

Op- if you have been making your own appointments all along then fine call yourself. If w/c has been making them then go through them.

 

[ChattiPatti]

You are right Weenor, I have not reached MMI. I was not discharged by the doctor or told anything other than my case was put on hold. The insurance company told me to set up an appt. with the surgeon. When they found out that the medial meniscus could not be fixed and that I would need total knee replacement, well, they flipped out and cancelled my appt. with the surgeon and told me everything was put on hold. I have still received my checks.
The doctor's office did inform me that he would not call in anymore precriptions for me without seeing me.
That is my basic question. When I call the insurance company to tell them I need to set an appt. to see the doctor, can they refuse this? Can they say my case is on hold and I will have to wait?
I do have an attorney who is like pulling teeth to get ahold of.
I will need to go this month to get meds.
So, basically what I would like to know is**************Can they refuse me to see the doctor?
My leg is not getting any better just sitting here. I want to get it fixed and get back to work.
I am not having any fun just sitting home with a leg brace that does nothing to help repair my leg.
Thanks