There is never a dull moment with WC patients like me I believe! Now that big company is filling 50 Kadian 10 mg. for 30 days when I take 2 per day! They are not going to fill my Celexa or other! How a big company like Travelers is a nightmare when I was awarded lifetime medical! My attorney is working on this but that takes time! My chronic pain continues and limits what I can do with continuing nerve pain and massive bilateral brachial plexathapy! Has anyone else run into a problem like mine?

Have you written your state & federal senators /representatives telling them all you are going thru when you have an approved claim? They need to know what these ins companies are doing with all the denials & delays...to people in pain..

I know a few in the past w/chronic pain did write and got some help with med approvals. Those may have been a private Ins , but denials/delays no matter what Ins company , needs to be looked into..

Squeaky wheel does get to the grease......

Hi Brachial6,

Didn't you have a similar problem last month, with getting the insurer to cover your pain medication?
Your attorney may need to take a different approach, so you (and your attorney) are not going through this every month?

In order to enforce benefits coverage, one must determine the governing body with jurisdiction.

If the company you were working for was self-insured (Federal jurisdiction), call the U.S. Department of Labor, Pensions Division. (Or maybe have your attorney do this. This launches an investigation into the employer, immediately.)

If the company you were working for is not self-insured (State jurisdiction), contact your State Insurance Commissioner's office.

Jo*Mar has offered good ideas, too. I would alert all Senators, Representatives, if possible.

This particular insurer has a negative reputation and is known to jerk people around as much as possible. After years of ongoing harassment, I put an end to it by reporting them to the appropriate agency. Never another problem with them.

I hope you can also receive the benefits due you... in peace.

DejaVu

You got great advice from Jomar and DV.
I would also add contacting the Attorney general for your state.

Yrs ago I had a problem with my health insurer, paid for by my corporation, while I was on short term disability. They would not pay for IV antibiotics my doc scripted for Lyme Disease.
I called the AG and they told me to call the legal dept at my company and say I was being denied prescribed treatment. My company called the health ins co and my treatment started the next day.

The attorney general is there to help with consumer issues and health care is a consumer issue.

Best of luck with getting this issue solved.
Shame on them for jerking you around like this.
My best,
D.

DejaVu, How do I report Travelers to who? Thanks for your advice I will do all I can! Jackie

Check your state website- for Ins board or work comp ombudsman??
Or do a web search for your state & where to report Ins carriers..
or something like that...

Hi Jackie,

As I had mentioned in my earlier post, first find out if your company is self-insured or not. This can be answered by your company's personnel office and/or by the State insurance commissioner.

If the company is self-insured, their insurance benefits are regulated by federal regulations.
Each region in the U.S. has an office for U.S. Department of Labor, Pensions division. Contact that number and a caseworker will take your complaint.

If the company is not-self-insured, they are regulated by the State insurance regulations, enforced by the State Insurance commissioner.

This is something your attorney can look into if you are not up to doing this. It can be a stressful process.

The Office of the State Attorney General sometimes has a healthcare ombudsmen's office. I know people have gotten help with health insurance benefits this way, as well. I do not know about cases of workers comp or disability obtaining help this way; however, a call to any of these offices will likely be helpful.

I don't have numbers for your area. You will find them under state and federal government listings for your area.


DejaVu

California WC complaints -
http://www.dir.ca.gov/dwc/DWC_FilingAComplaint.htm

http://www.dir.ca.gov/sitemap/sitemap.html

Great link, Jo*Mar!
It looks like California has an outstanding system in place!
Fantastic!

(Not every state has such a robust WC division.)


DejaVu