PT question
 

The PT facility has advised me that it is not uncommon for WC to shut down PT, they see it all the time, but they are still putting in an appeal to WC.

They assured me I can have more Aqua PT via my health insurance, because the PM doctor prescribed it and WC denied it.

Has anyone heard of or used this stragety?

Also WC wrote that I should be well enough to improve via home exercise. If only I had my own heated, salt water pool this might be correct. :eek:

I have and I can tell you that it gets tricky. Your insurance will pay...but you will have to pay all copays and deductibles and stuff so there will be OOP costs. Also...it opens the door for lots of issues with work comp down the road. Once you start paying for treatments under your own insurance...things can get complicated. The theory is that YES...work comp would eventually have to pay and would have to reimburse you and the insurance company for any money paid out. The reality is that things get complicated and it could be a LONG time before you see that money back...if ever. Which leaves it up to you on whether you are able to wait it out...or if you need to continue treatment ASAP. Do you have an attorney helping you? They should be able to push the issue with work comp. In many states there is a penalties petition that can be filed if work comp is needlessly delaying treatment, TTD, or any other benefits without cause and usually even just the threat of that gets them moving in the right direction...from my own experience.

Thank you Catra,

I have no attorney and I am worried about being caught in the middle. Right now I have no co-pays or deductible, because my husband is paying for me to have top of the line secondary insurance, due to my brain aneurysm surgery and potential problems arising from CRPS that WC might deny. We decided to buy this level of coverage for two years after number crunching.

Medicare is my primary insurer, on their site they explain that they will pay if WC denies, with provisos for future re-payment from WC.

I am currently owed a bundle for co-pays I made in the past two years, but that reimbursement should be coming from the doctors and hospitals who were paid by WC after my previous insurance co raked back their payments. I was told by the doctor's billing offices everything would be automatically refunded once WC paid the bills, but as yet I have not seen a single dime returned.

So it sounds like you are at least somewhat familiar with the system and the financial side. The biggest problem is that once you start paying through regular insurance it opens the door for work comp to start denying other stuff. BUT...if you need the care now then you need the care now. I've always had a lawyer when things started to get this complicated to help with getting work comp approval on stuff...I'm sure there's some method for an individual to do what the attorneys do to appeal the denial...but I don't know what it is (and I'm sure its different in every state). At least with the level of insurance you guys have then you immediate OOP expenses would be small or none. Its a hard decision to make...I am going through something similar myself and am unsure what I want to do about it...

I would call WC and ask them if they paid them yet. Keep track of things on your end, or you'll always be in the dark.