Insurance Company Ignoring Me

[ChattiPatti]

What is the name of your state? Florida

I had recently made a post where the insurance company cancelled my appointment with the surgeon when they found out I needed total knee replacement.
They told me things were on hold.
Well, that has been almost a month now. My attorney has not heard a word. I have not heard a word.
So yesterday I called them (insurance company) to see if there was any updates. They were very rude and more or less said "we don't know what is going on".
What do you think they are doing? Why would they choose to pay me to sit home when I can get surgery and get back to work. Doctor says I can not work.....
I have never had any prior injuries to knee, so they can not say that.
Any advise?
Thanks

 

[lumbarpain]

sounds familiar

I am not an expert on this but I can tell you that I live in Fl. to and I am going through basically the same thing.I hurt my back nearly 15 months ago and now am waiting for the insurance company to approve my surgery for a lumbar fusion.First of all if you hired a lawyer you not supposed to contact the insurance com. personally,it will all have to be handled by the attorneys.The insurance com. might send you to another Dr. of their choice to try to prove you might not need the surgery.Has your attorney filed a petition for benefits?If he has ,the insurance com. will have 30 days to respond or it will go to a mediation.They may try to prove you do not need the surgery or they just are dragging their feet which is very common.If your att. has filed a petition you can access it at the website,www.jcc.state.fl.us.You will have to know your case number or ojcc# to see your info.I hope this helps you a little.

 

[ChattiPatti]

Thanks for your response.
Since I had posted the first post, the insurance company has set me up an appointment to get a second opinion, which is on June 28th.
Yes, I have an attorney. He has taken over things, so I won't have to deal with the insurance company.
Thanks again, and hope all goes well for you.

 

[BlondiePB]

Thanks for your response.
Since I had posted the first post, the insurance company has set me up an appointment to get a second opinion, which is on June 28th.
Yes, I have an attorney. He has taken over things, so I won't have to deal with the insurance company.
Thanks again, and hope all goes well for you.

If that appointment is an IME, do not be surprised if the physician does not give you any prescriptions. I knew you did not reach MMI. Your case being on hold does not equate to you not receiving medical care.

 

[ChattiPatti]

According to the insurance company this is to be a second opinion to see if this doctor feels that I need the total knee replacement.
The way they do things, nothing would surprise me if they all of a sudden say well this doctor feels you can return to work full time. They have a bunch of tricks they pull I am sure.
The appt. is on June 28th. I will keep you posted as to what was said and done.
Thanks for responding.

 

[ChattiPatti]

Bye the way what is IME?

 

[weenor]

Bye the way what is IME?

Independent medical examination. Usually set by the insurance company to perform an evaluation either of the reasonableness and necessity of medical treatment, or of permanent impairment.

 

[barrryyy]

Quote:
Originally Posted by ChattiPatti
Bye the way what is IME?
An IME is basically a "hired gun" for the insurance companies. You should be VERY careful what you say and how you present. My lawyer suggested carrying a recording device to tape the "exam" I received. Many of these "independant" drs make the bulk of their income from fighting for the insurance companies. Many of them are failed drs who are semi-retired and very belligerent. They are not "independent". Do NOT allow a reprentative for the insurance company to go into the exam room with you.

 

[ChattiPatti]

Thanks for your input.
I know that this doctor is for the insurance company.
The one thing that I believe I have going for me is that the xrays and MRI can't lie.
It is right there that my knee is bone on bone and the meniscus can't be repaired.
I have never had a knee injury before this accident. I have never really had a problem with knee before this happened.
I understand what you are saying though.
And I do believe they are sending a rep from insurance company who is supposed to be a Nurse Case Manager. She will not come in room with me.
Thanks again.

 

[abaga]

Quote:
Originally Posted by ChattiPatti
Bye the way what is IME?
An IME is basically a "hired gun" for the insurance companies. You should be VERY careful what you say and how you present. My lawyer suggested carrying a recording device to tape the "exam" I received. Many of these "independant" drs make the bulk of their income from fighting for the insurance companies. Many of them are failed drs who are semi-retired and very belligerent. They are not "independent". Do NOT allow a reprentative for the insurance company to go into the exam room with you.

An attorney friend of mine calls them "Insurance" Medical Exams! You are right, there is NOTHING independant about them!!

 

[ChattiPatti]

Had second opinion done

Ok. Went to the doctor the insurance company picked. No-One from the insurance company was there.
This doctor looked at all reports, looked at all x-rays, MRI's.
He did an exam of leg.
He thinks that I am too young (53) to have a total knee replacement.
He did say that the medial meniscus cannot be repaired. My knee is bone on bone. I also have osteoarthitis in knee.
He said that perhaps they could go in and clean out some cartlidge, and see what that would do.
So now it is wait and see what the insurance company decides to do. I am sure they are going to jump on the removing of he cartlidge.
My question is? If this does not improve my leg and I am still unable to stand for long periods of time and it still swells and hurts, I can go back to doctor right? I am not going to close out the medical part of this. Also, does this case always stay with the same insurance company even if I switch jobs somewhere down the line?

 

[abaga]

Ok. Went to the doctor the insurance company picked. No-One from the insurance company was there.
This doctor looked at all reports, looked at all x-rays, MRI's.
He did an exam of leg.
He thinks that I am too young (53) to have a total knee replacement.
He did say that the medial meniscus cannot be repaired. My knee is bone on bone. I also have osteoarthitis in knee.
He said that perhaps they could go in and clean out some cartlidge, and see what that would do.
So now it is wait and see what the insurance company decides to do. I am sure they are going to jump on the removing of he cartlidge.
My question is? If this does not improve my leg and I am still unable to stand for long periods of time and it still swells and hurts, I can go back to doctor right? I am not going to close out the medical part of this. Also, does this case always stay with the same insurance company even if I switch jobs somewhere down the line?

I have a cousin who had the problem you mention above, and even after going in and cleaning out her knee, she still had swelling and pain. She ended up having a partial knee done. She was 54 when hers was done.

Why does this Dr. think you are too young for the replacement?

 

[ChattiPatti]

He says because of my age that I would surely need another one done. He feels that they only last about 12 years.
I am sure this is why the insurance company is trying to shy away from doing it.
Did the partial replacement help?

 

[abaga]

He says because of my age that I would surely need another one done. He feels that they only last about 12 years.
I am sure this is why the insurance company is trying to shy away from doing it.
Did the partial replacement help?

They last about 15 years according to my cousin's Dr. Whether it is done now or you wait 5 years, it will still have to be replaced at some point. My cousin was in more pain after they went in and cleaned out her knee then when the replacement was done.

I wish you the very best....

 

[ChattiPatti]

Has been a month now

Well, it has been a month since I seen doctor for second opinion. Surely the insurance company has received his report.
I have heard nothing. From the insurance company or my Attorney.
They are still sending my checks. I thought I would hear something by now.
I don't know what the hold up could be.
Want to get my leg fixed and get back to work**************.