W.C. Insurance is now playing 'games'....
 

Hi friends,

This will be brief as I am so tired...but more so I am angry, frustrated , and scared..

I was notified today by Stanford that WC did not authorize two out of three appointments for next week...... the two slated for march 16th ( a complete physcial therapy eval by a doctor, and a pain psych eval by a PhD specialist) were not approved..

The apointment scheduled for Friday March 19 was authorized. Ironically (or with calculated WC manipulation) that is the appointment when my new pain doc and the other two specialists were going to conference with me for treatment strategy...except my new pain doc won't have any info from his team.......

I am so upset, crying, and now wondering what else they won't approve....
Then Stanford will begin to wonder, too....and won't take my case seriously because approval is unreliable...

I won't give up ...I e-mailed my attorney and he is going to try and help me through this...he thinks they are now playing games.......
How horrendous is that...playing with people's struggle for relief...........

The information from all of you (Sandy, Mike, and Sk8ter) sounds so promising and hopeful..thank you for the research and the time it took to review it and pass it on....I am so grateful to you. I read trhough all of it and these innovative treatments can provide some relief..

Writing this has helped ....I have to try and regain balance as I am so upset, scared, and furious..

Thank you for being there..
I hope you are coping with your challenges as i feel them in my heart.
hope4thebest :grouphug:

Dear H4tB -

Unbelievable. I'm so sorry you're going through this.
:hug:

Mike

Use your regular insurance
 

Dear H4TB,

Do you have personal health insurance? Whenever WC denies my treatments or meds, which is often, I use my United Healthcare. It is a valid claim if it has been DENIED. Usually The Hartford starts playing games when a new doctor or treatment plan is on the horizon. When I switched from using a RI doctor to a Boston doctor last year, the harrassment was severe. And again this year, when an application for ketamine treatments was submitted, the harrassment began again. Meds that I have taken for over a year have been denied at the pharmacy, my lidocaine infusions in Boston have been denied, and of course, the ketamine treatments have also been denied.

So because I dared to dream of maybe getting better with ketamine, I am being punished now by WC by not being approved for ANY medical treatments at all while we wait for the courts to act on my case, which could take weeks or months.

I have also shed many tears over the cruelty of the WC system. My adjuster and her team are truly evil individuals who have wasted an incredible amount of money on legal fees and have caused me enormous suffering. I just don't get it.... There honestly has got to be a better way to run things. Until I got sick I had no idea what "WC" was all about. This is insanity.

If you can, pull out your personal insurance card and just hand it over to keep your plans intact. And let your attorney handle the rest. Try not to get too uptight. And console yourself with the thought that God must have special plans for evil insurance adjusters who prey on older sick people who continue to work in spite of their pain.

Love and peace, Sandy

Another issue for either a good worker's comp. lawyer or an attorney who routinely sues insurance companies in general, is whether, as a form of "insurance" created and not simply governed by state law, a carrier is subject to a claim of "first party bad faith" under state law.

I know such claims against a heath insurance company, whose "IRS qualified" benefit plan is made available to you through an employment relationship, is subject to ERISA pre-emption: federal law takes over. The potential distinctions here are that (1) workers comp exists solely because of state law and varies from state to state, and (2) the employee may be deemed to have opted out of his/her ERISA pre-empted company health insurance by filing for WC in the first place.

On account of which, there may - to the extent that the WC legislation doesn't bar claims against carriers in it's own right - be a higher standards before state bad faith law as applied to WC carriers can be found subject to federal pre-emption, e.g. a statement of express intent in the federal legislation as opposed to what we have now, Supreme Court caselaw, made out of wholecloth, that ERISA constitutes a complete "occupation of the field" in matters pertaining to employment benefits.

It might be worth asking about anyway.

Mike

I called Stanford yesterday and left a voicemail for the person who called me to say the two appointments were denied. I e-mailed my attorney...After many phone calls back and forth today.. my last call to Stanford had good news....

She said that WC told her that WC had made a mistake........
that the appointments on Tuesday were authorized ....and that they told Stanford they were not authorized...in error
If I had not made calls and e-mailed my attorney, etc, those two appointments on Tuesday would have fallen through the cracks....the appointments were re-instated for Tuesday..

My heart goes out to people who don't know how to navigate the red tape, and the duplicity...
"Hmmmm, let's make a "mistake" and maybe no one will question it..."

I am hoping this was not the case...I am hoping that indeed it was an error.

My left foot and lower leg are off the charts with burn and are beet red(can lidocain patches cause this)...it is getting worse daily....and spilling over to my right limb..I hope the new team can help, and the ins. cooperates.

Sandy, you are on a treacherous path with your situation and I hope you have enlisted an attorney who will support you, is knowledgable, and is a warrior, ready to battle for you..
The irony is that we try to remain peaceful and find equanimity, while having to pounce at any moment to protect ourselves...

I cannot believe that WC has halted any treatment for you while you wait....
Can Mike's information re: "first party bad faith" apply to your situation?
Dear friend, I am by your side...especially on Tuesday..

Mike, I will keep your information at hand in case additional "little errors" at the 11th hour surface over the next several weeks..I know you go through a lot of effort and time to excavate the information we need..you are incredibly kind..

Hope4thebest :grouphug:

Great news ... your persistance paid off. A terrific lesson for all of us.

My lawyer's office response to my situation is that "it's just comp." These are the games that they routinely play. Especially the Hartford, which is the worst of the worst. I will definitely follow up on Mike's suggestion. TY Mike.

H4TB, I'm sorry your legs and feet are getting worse. Another type of pain patch that I use, in addition to the Lidoderm, is called "Flector." It's got a Motrin type substance in it called diclenofac which helps reduce swelling. Have you tried them yet? Diclenofac is also the active ingredient in Voltaren gel. Perhaps you could discuss a script with the docs you are meeting with this week? I also find Skelaxin, which is a muscle relaxer, very helpful at bedtime.

XOXOX Sandy

Dear H4tB -

Now I remember why that abstract re the Stanford BTA blocks looked so familiar, because I posted on it back in Novermber!!!

See, LSB with botulinum toxin to treat CRPS or Stanford Pain Med., the good and the ugly at http://neurotalk.psychcentral.com/sh...d.php?t=109277:

In the article, the authors explain how this unfunded pilot study took just under three years to recruit 9 subjects who met the author's rigid inclusion criteria (essenetially people who had had lower extremity CRPS-1 for at least six months, failed other therapies, and yet still had at least a 50% reduction im pain, lasting 4 or more hores to conventional sympathetic blocks) and while they hade been hoping for ten subjects, they finally cut it off at 9. And of those 9, only 7 of the subjects could be used in the end. Yet out of the 7, statistically significant results were obtained . . . .

So what's the Stanford UGLY? Something that appreared in the htlm copy of the article, but inexplicably didn't make it to the [PMC] pdf file I've shared with you. Immediately after the Conclusion and before the References, the html copy has the following:

Footnotes
Potential conflict of interest: The authors report filing a patent for the use of botulinum toxins in sympathetic block.

Additional Supporting Information may be found in the online version of this article. [Empahsis added.]

[A couple of typos cleaned up in quoting from the prior post.]

http://www.ncbi.nlm.nih.gov/pmc/arti...ool=pubmed#FN3

There's more re the issue of patents on medical procedures, including the case now under submission in the Supreme Court, which may well be an end of term blockbuster.

But the fact that I entirely forgot about a thread I put some time and energy into less than 4 months ago just blows me away. And it's almost as creepy as the notion of medical school professors being, shall we say, circumspect, in describing their selection criteria, as in greater than 6 months (but just maybe less than 9).

Mike

Hi Mike,
I checked back to the post of November!! There it was: lumbar blocks with botullinum toxin to treat RSD!
I probably didn't retain it because back in November, the treatment hadn't been suggested as yet...

I also probably didn't retain it, because things are slipping through my brain like a sieve and disappearing...

Fear not, you probably didn't recall it as you have posted so much information for all of us, it's hard for your head to keep a current and updated file!!

I printed the information and will review it in detail before my appointment on Friday...At this point I doubt that I would be a candidate, as the lumbar block they gave me a couple of weeks ago with just bupivacaine and clonidine did't really have an effect...in fact, it seem to flare and stir things up. Therefore, I couldn't provide a baseline of relief to compare a subsequent block with BTA..
This will be an interesting week...

Sandy:
I actually have a couple of flector patches that my foot doc had given me that have not yet expired...I hadn't tried them, as I was using the lidocain patches ..I'll try one tomorrow..thanks for the recommentations, and I will bring them up on Friday..
Please let us know how your Tuesday appointment goes..I will be thinking of you!


Hope4thebest xoxo

It would be so nice if you could get ketamine approved right away. Once the blocks stopped working for me, and I was experiencing spread, I moved on to the lidocaine infusions. I've now had 7. They do work for a little while (like a week, at about 30% or so) for my pain, and they seem to build on each other. My first infusion was in July 2009.

Ketamine is the most effective treatment (70-80% complete success rate) to date for RSD. You might want to bring that data with you to your appt. (Dr. Schwartman's and The Netherland's double blind studies that were performed in 2009). There are a number of places that have ketamine in California - 3 in LA and 1 in La Jolla, according to a list that I got from Jim Broatch.

XOXO Sandy

I know that most docs are saying that a SCS can help and I wouldnt recommend it just from my experience. Especially if they are wanting to implant this via surgery because surgery usually gives the rsd a chance to pop up somewhere else. It does work for some people but for others not so much.