I give up on the whole system
 

Ok ive put it off, because I knew it would cause me more grief , but today i thought I had it in me to deal. Im talking about setting up an appointment with my pain psychiatrist. last time I went they advised me that I needed authorization in writing from comp. that they intend to pay. Now comp in NY does not work that way, I see a dr they billcomp they get paid or denied then I get billed and have to fight for payment if an issue is present, but this DRs office said I will be responsible for paying the office visit the day of visit if I didnt have written authorization. now I spoke with atty, as last time I had a hearing this was brought up and judge "said" as long as I had resonable need for it, then he looked into notes and said he found sufficient evidence supporting the need, of course my written decision did not have that on it. Ok so atty said that the dr,s office should call carrier and get what they need them selves, so I called Dr,s office back. they said sorry. they do not do this. Now Im pretty confident I understand all the laws for comp, but to make sure I call NYWCB and using my WCB# I ASKED LOADS OF QUESTIONS.. just to be walled out . they said to ask my attorney they will not discuss this with me. so . angry and defeated I still refused to give up, so i searched the internet for answers, (not easy to find out detailed laws for NY workers comp)finally I got a hint to what i was looking for so .. again I called NYWCB. this time I asked questions that actually reaped benefits.. all that work to find I understood the law better than my atty,s office. so Here in new york ; any doctor participating in Ny WCB must accept the patient, with out authorization ,(those are meant for tests costing more than $500) and then bill comp with evidence of needed follow up of clearing the patient from future need of their services. and that is Against the law to bill PATIENT for service,s prior to a denial from the carrier and the NYS WCB> all that said this is a psychiatrists office and their job is to care for the mental stability of a patient, this BS is not in the best interest of mental stability for the patient. this being said, though I HAVE seen this dr before ... I shal not return, and I am now completely done with the system. .. the treatment of a patient should come first,, and their wallet should come secondary or better yet??? further down the line. this also further strengthens my distrust of psychiatry.. (hi let me see you to help you out.. the way I do that is to 1.) make sure you can afford me ,, if not tough poop you suffer with the paupers. 2.) seat you down whilst i pretend to listen, and I catch up on some Z,s after my late night partying on the money paid to me by the poor schmuck I saw yesterday, then when you are done give you some of the same repetitive advice that means nothing that I gave the poor schmuck yesterday and day before. then tell you that you must follow up because you need help and must get better.. but the real reason is.. you just bought a third house an new BMW, yacht and you have a big trip planned to Europe and this all needs to be paid for.. If they really were in it to help people, the last thing they would deal with is insurance and payment.. I mean come on .. 600 dollars for 30 minutes.. and then you complain that your landscaper bills you $40 a weak to mow your lawn.. 120 for fertilizer, or $35 and hour per person for landscape design or other labor work not maintenance related?? yeah they are not in it for the patient or to help and make a difference. they get paid to be judgmental , for stature, and accolades . so stop lying to us..


Sorry .. had to Vent.. other wise It play over and over in my head tonight while I pretended to sleep so my wife wont worry.

Thanks again for letting me.. I hope every one is doing ok.

Painman, I have so much respect and admiration for all of you over the pond who have to fight with a health 'care' system that completely sucks. I'm sorry you had to waste so much energy on just trying to get some help.

I apologise for the following rant :mad:

Healthcare should be just that - caring for your health. To have one that is centred around the $$$ first and foremost is so so SO wrong. I am angry and frustrated for everyone who has to juggle a twisted insurance system at the same time as being ILL. I can't believe that the system got put into place initially, let alone that it continues without anyone in authority pointing out the massive white elephants in the room:

- THE SYSTEM DOESN'T WORK
- IT CAUSES SUFFERING TO THE SICK AND INJURED
- CHARGING FOR CARE MAKES IT EASY FOR DOCTORS TO BECOME GREEDY PEN-PUSHING SELF-SERVING INHUMAN MONSTERS - and rewards them if they do
- MAKING IT ALL ABOUT THE $ MEANS THAT DOCTORS HAVE A VESTED INTEREST IN YOU STAYING SICK

I'm sorry to shout and point out the bleedin' obvious, but I find it deeply disturbing that your politicians can keep ignoring all of the above. I really hope that they see sense (or find a teensy bit of compassion) soon. You deserve real care, not a sham of manipulation and accounting.

Take care of yourself Painman, as it appears that no one else will. I hope you have a better day today, sounds like you know your own mind pretty well, although being able to talk about your complicated feelings to a professional would have been useful (only if they are any good though:rolleyes:).

Bram.

Ugh...I'm sorry you are having the struggle with doctors and insurance.

I seriously feel your pain. I no longer could afford my $820 COBRA premium. I now have been uninsured for several months because of course no one will insure me with pre existing conditions. My state Medicaid approved me, yet made my deductible nearly all my income ( which is long term disability insurance). I'm waiting on a trial for SSDI who of course denied my original application. My pain doctor wants to try different medication that I can't afford without insurance.

The "system" sucks!! It is so frustrating and stressful. I hope things finally work out for you.

I'm my wife's advocate who has RSD. As someone who does not feel the pain, the stress dealing with doctors, hospitals and insurance was killing me. Within two years my hair turned gray. I can not even imagine someone with RSD and also dealing with these issues and Workmans comp also, whom, by they way operate on the premise of deny deny deny. However, October 1, 2013 may offer many some hope of reduced stress. Whether one agrees with Obamacare or not, the fact that these exchanges will open up to the public. Costs are based on a income sliding scale, Pre-conditions no longer apply and no cap on coverage. There's plenty of propaganda out their but what I have gathered so far, rates in some states will drop 50%.

I wish you reduced stress painman2009. Hopefully, and in time, issues will simmer down. It just takes time and patients.

I totally feel for you in this. I pretty much lost faith in the system a long time ago. This is the main reason I ended up settling my work comp claim. Even though it wasn't "right" to settle and to settle for so little an amount compared to what my bills were...I just couldn't deal with it all anymore. Work comp, the appeals of my case, my own attorney being a bully, doctors who just didn't seem to care about what I wanted and just wanted to do expensive procedures, etc...it just got to be too much. So I sat down and had a good hard think about what was best for me long term. I don't know if 10 years from now I will feel the same way (because who knows what the future holds) but my life has gotten SO much better since I made my decision. Not the pain...cause that's just something I live with and accept at this point...but all the stress, the anger, the frustration, etc are gone and without them my QUALITY of life is so much better. It's not the right decision for everyone...but when you get to a certain point you need to sit down and look at ALL your options, weigh the consequences of each, and decide what is best for YOU.

The doctor I was seeing (who I love and who has been my biggest help and support through the last couple years) is not "out of network" and I won't be able to afford seeing her. I have had to go back to the office where she first started out (she's moved twice since then) and I like the office...but they are pressuring me to see a pain specialist again. I don't want to...they have nothing to offer me at this point so I don't see the point in wasting their time and mine. We'll see how that shakes out...but I get so frustrated with doctors who can't seem to LISTEN to their patient and wrap their heads around what the patient feels is important. I know not everyone will agree with or understand my many reasons for wanting to come off all pain meds...but that's MY decision based on my own experiences and knowledge about what is best for me both physically and emotionally.

And I don't want you to think that any of this means I am not a fighter...because I am. It was so HARD for me to make the decisions I did because they felt so much like I was letting work comp win. But at the end of the day...fighting their battle was only going to result in me losing in the long term because it would mean years and years of battling them for approvals and medical care which would keep killing me financially, emotionally, and physically. So maybe they felt like they got a win from me settling...who cares...I know I won too.

I am so sorry you have to go through all this painman and I really hope things start to look up for you soon. Take care of yourself...things can and will get better...you just have to find your path.

Yes, the new health care may offer reduced costs and sliding scales BUT doctor's will still have a choice as to whom or what conditions they will treat.

As a chronic pain patient already knows it is difficult just finding a compassionate doctor willing to take on the complexities of such.. it will be worse as these new laws take effect. Not only will it be more difficult to find a doctor it will be even more difficult to get an appointment. Wait list for specialists will be much, much longer and that is a guarantee!

I feel badly for anyone fighting the workman's comp battle but, to blame doctors for the mess that it is not fair. They aren't the problem it is in part the fault of many, many individuals who choose to be fraudulent and corporations who blatantly disregard the safety of their workers and then spend millions to fight paying for care rightfully deserved by the person suffering, so that they can continue operating in hazardous ways.



Just my two cents,
Tessa

well here it is .. workers comp was designed to be an aggreement between worker and employer that if injured worker will not sue . so it is protection for the employer .. not the worker.. verbatim from WCBNY.com
.. its bull honkies .. as an injured worker we have no real guarantees . and our rights can be taken away in the blink of an eye. by the suites..
ok to dramamtic?? go out on comp, be treated like criminal for your injuries.. youll see. the treatment is totally un american, guilty first prove innocents.
and if they take a picture of you ..TRYING to do something they use that single picture to tell a false story.. they never say what happened after the pict was taken.. but this is what is considered fair under law.. yeah for who.. the victim?? not

Hi Painman
 

I am sorry you are having issues with WC in New York. I do know another gent on this site, who is having problems with them too. He worked at Lockheed for 33 years. He needs surgery to fix his spine. They deny him and send him to crack pot doctors. He is also angry like you are. He can't get the help he desperately needs. I hope very much for the both of you, that WC will do the right thing by people. ginnie

What a friggin hassle (that’s an understatement) for you Painman. Just what you need, a little more stress. It seems as though everything is a fight. Fight the doctors to listen, fight insurance to pay, fight the stress and pain from fighting all the damn time. The healthcare system in the U.S. has become that of a third world country. The costs that are billed for care are obscene, if not laughable. Bram is right, there’s no money in a cure. It doesn’t matter if it’s cancer or CRPS.

I am a casualty of being self-employed, and premiums became out of my reach when the economy went in the toilet back in ’08. We held on until 2010 until premiums for JUST ME were over $1k per month! Right, I can totally afford that, and the co-pays, Rx, etc. I am now at the mercy of my state’s system. I waited a full year to see a neurologist. I had access to a primary care doctor right away, who at my first visit said I was out of his scope of practice and wouldn’t so much as prescribe gabapentin. Can you believe that? Like I’m looking to take anti-seizure medication for the hell of it. He ended my visit by telling me I need health insurance. Wow, he’s a really smart guy, hu?

I would file for disability, God knows I qualify, but since I was self-employed, my accountant didn’t tell me that because I am self-employed I should have filed taxes a certain way to be covered. If I had filed taxes differently, I would have been covered. So basically it’s like I didn’t work for 10 years and I no longer have work credits. That too is laughable. I have worked harder being self-employed than I have worked at anything in my life. I have worked since I was a young grade school kid throwing newspapers. All I can think is all the years I paid in. I want my money back!!

Anyway, I hope you are somehow able to get the help you need. I feel for your situation.

My wife worked for Lockheed for 15 years at their corporate headquarters in Bethesda, Md. in Benefits. When she got sick with RSD she knew exactly how they'd dump her and it was not a WC case at all. Regardless, the doctors certainly did their duty to deny care for years. Not the case at all when she was put on my insurance. A law firm thought that was very telling.

Vrae, that is a very bad place to find oneself! Like I stated in my earlier post, whether one likes the idea of Obamacare or not, that really is not the issue, but it could work in your behalf. Pre-conditions eliminated, affordable rates and subsidized if need be. But the issue could be what an earlier poster had stated in that many doctors may not except the coverage. That can happen but what may come out of it is if millions are effected by this behavior, pressure to change the system quickly could take place also. At one point we lost our coverage because of the economy and I had to pay out of pocket for my wife's care. We came within a hair's width of losing everything. I contacted my congressman whose staff helped us keep our home by keeping the dogs off our backs and sped up my wife's SSDI, which took 3+ years to acquire. The stress was horrible.

I really don't want to go too off topic as respect for the OP of the thread, but I feel I had to say something. Tessa I'm assuming you have health insurance and haven't yet got to the point where you are fighting with the state for Medicaid or being turned down for private insurance because of preexisting condition(s). You may be a little more supportive of the new system if that was the case. I am paying out of pocket for every appointment, test, hospital visit and prescription. I can't wait until I am able to get health care again because of the new system. Even when I was working and had great insurance ( paid for by my employer) I believed everyone should be able to have affordable health care.

I don't believe the affordable health care act is perfect by any means and was not the plan Obama originally intended. I think a lot of people are jumping the gun thinking that there are going to be many problems when we really don't know until it is fully in effect.

Oh trust me - I have dealt with every aspect of not having insurance or having pre-existing conditions!! My first born spent most of her 6 years of life in the hospital fighting for her life and we had no insurance. Years later, I was diagnosed with cancer and fought for every single treatment including chemo/radiation multiple surgeries, transfusions etc., without private insurance.. my husband sustained a fracture of his spine at work just last November so YES we are intimately familiar with WC and other insurance or lack there of .. issues.

My words were only to say that it will be more difficult to find doctors willing to treat those who are on the new plan. I also stated how much more difficult it will be to get an appointment because wait lists will be high. I was not saying anything against or for this new healthcare policy just making comments as to future difficulties such programs can cause. If I offended you or anyone else that was not my intention at all.. I am just as angry at our system (WC/Medicaid/Medicare) as the next person!!

Lastly, I pointed out that it is not the fault of the doctors that WC makes people jump through endless hoops trying to get treatment rightfully deserved - it is WC state laws that doctors are required to follow.

Sorry I must have taken it the wrong way. Probably due to hearing so many people going on and on about how horrible it is going to be.:sorry:

lol.. no apologies needed :) It is often difficult to truly portray our feelings when typing into these little boxes :/

I wish we could all get the care we need without all the factors that make suffering much worse.. like fighting WC.

Sad... no matter how you look at it.

Have the best day possible!

Hi Jimking
 

In my fathers day, when you did your job well, you received benefits if you got sick. Like your wife asked for the RSD right..... Being denied when you did all the rights things is horrible, and a reflection on insurance on the whole. I was self employed, unable to receive any insurance at all. pre-existing conditions. Dumped out of the insurance pool altogether. It took me four years to get disability. I had extinguished all savings of two generations. I feel a great deal of empathy for those fighting for their health care. ginnie:hug:

My understanding of these exchanges is one will be able to pick the kind of coverage they want. Another words if you want an HMO or a PPO or something more costly you have the choice. BCBS PPO will be one of those choices. Now, if someone who has very little income my hunch is they will not be able to acquire BCBS but medicaid only. Medicaid only or a low cost HMO is where I think one may have an issue getting prompt attention when needed. But I could be wrong. However, change from the old system was going to happen anyway, there is no doubt about it, so I do believe the changes will not stop on October, 1. I think more changes are on the way especially state by state changes.

Just a small reminder that our guidelines do mention limiting of political type discussion/comments.

We know with health care changes there will be some discussion, which is fine, but leaving the politics out of it will be best for all of us.:cool:
Just helps to avoid arguments and bad feelings..

Oh no no no, JimKing my rant was not directed at you hon. Heck I helped to vote Obama in for a second term to ensure the Affordable Healthcare Act would happen for the very reasons I mentioned. Let me just follow that up with Obama has lost a lot of good graces with me personally. Just too many unkept promises, as is the case with most politicians.

I am so glad that you were able to eventually get your wife covered and not lose everything in the process. I think it’s ridiculous that one must fight the government for benefits that you’ve paid in to receive. I mean it’s well known that you will be denied the first time you apply for SS Benefits. Or at least VERY FEW receive benefits on an initial application. And then IF you get approved, more than likely you’ll be waiting another couple of years to be able to use it. That’s insane! And to add insult to injury, after the first couple of years you’ll be forced to requalify. Good grief! This was to my point of having to fight for everything, it seems.

ut oh.. whoops. :eek: I made my last post before I read this. Sorry about that. I hope I didn't go overboard.

I do not want to get political but the bronze, silver, and gold plans under ObamaCare have HIGH co-insurance which is unaffordable to many. Who can afford a 40% co-insurance for a hospital stay? That is the co-insurance for the bronze plan, the most affordable plan by premium cost. Because of ObamaCare, many hospitals are closing, being leased out, etc. Doctors are taking early retirement, going to be staff at hospitals, leaving private practice, charging an annual fee for a concierge practice, etc. These are not things I have read but have personally seen in my community. I fear what my personal health care future will be under ObamaCare as I have several specialists I see on a regular basis for several different health conditions. I already pay $1000 per month for my health insurance with high co-pays. Just wanted to mention that ObamaCare may not be "good" for everyone. Some may benefit and some may be "destroyed".

I agree. This may very well be the case.

Sorry
 

Dear JoMar

I did post a reply that I guess I should have refrained and I apologize but the comments pushed me into a reponse. I do apologize and do respect that this is NOT the forum for political views. I will be sure not to lose control again and respond. Thank you for the reminder. Again, my sincere apology for losing control and posting a response.

Hopeless

Well, its going to be a nightmare if my wife has to requalify because she has given up with all the doctors, their fears of the DEA, poking and prodding...Doctors not excepting medicare leaving only a few who will take medicare and those doctors, to me, appear to be scumbags for some reason. I can go on and on. My wife stopped every narcotic last summer. She said, and I believe her, that those meds just did not do the trick and the stress they caused was not worth it. Now explain that to SS....

Duuuuude. so true, one of my biggest problems right now is durning a workers comp overhaul in 2010. alot of Dr,s dropped out of comp, I no longer can find a vascular surgeon, Psychs re really limited, same as places I can go for testing.. what a pain in the......

Yeah I think none of us will really know how it is going to be until it starts. I'm hopeful that it will make things easier and more accessible :smileypray:

I have been in the WC system a VERY long time in CA and consider myself lucky to have been injured prior to "reform". For things that are not emergencies, I have found you have to accept that it might takes months and you might need the intervention of your attorney. This can mean unnecessary complications to your health and it costs WC more in the long run--penny wise and pound foolish IMO. I have found that every few years they seem to try and make my life hell (likely to try and get me to settle) but if you can stomach those periods they will generally give up. Switching doctors offices might be needed if they have a policy that seems unusual. Finding a doc that has fewer WC patients can sometimes help. There is a WC site that is state specific if you want to dig in and fight, I'll hunt it up if you're interested.

Hi Painman
 

If you could post that about WC, to Don1956, I think he would appreciate it. He is in SNY and is having the same kinds of problems with doctors and WC. They just finished sending him to someone who represents WC, sounded like a quack to me. They are denying him surgery he really needs. I cannot believe how many hoops a person is made to jump through before adequate care is received. He has a lawyer, but it may be months and more hoops before anything can be resolved. I am so sorry you have had to go through all that. I hope your own situation improves to where you care is given 100%. I would transfer the thread myself, but my own abilities on the PC arn't so good. I never really used a PC before I found this site. I have a lot to learn. I will keep you in my thoughts. Please give my best to your wife too, it is good you have someone by your side while you go through the hoops. ginnie