Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.

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Old 09-22-2010, 07:46 PM #1
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In California, the adjusters are serving us with Utilization Reviews which halt our treatment while the doctors duke it out with ridiculous written reports.

All of this time causes us to suffer as the treatment is delayed and the doctors decide to "drop us" as problematic patients.

I am now seeing them do them for the rest of the patient's life, as long as they keep their med "open" instead of settling them by Compromise and Release. This is giving the medical insurance industry a huge and unfair gain as no patient wants to suffer and lose time for healing or surgery or pain, as well as lose GREAT doctors simply because the doc doesn't have the time or money to handle this.

This must go to the presses. The attorneys don't care - they say, so what, go ahead with whatever the insurance co. says...not caring that it is our bodies' healing and outcome at stake.

I am livid to say the least.

I argue a judge should have the final say, but my attorney says the judge can never have a final say because meds change - yeah, they change, that's why the decisions and therefore the law must exempt medications!!!

If you have been URd for a medication, PLEASE PM me. We've got to fight this - this will destroy work comp, I am warning you all!!!
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Bobbi (09-24-2010)
Old 09-24-2010, 02:29 AM #2
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I know that this may be a bit of a "touchy" subject for some (as it is for me, since I don't want to clearly ID myself for my own insurance people):

But - and perhaps others also want to ask but may also be afraid or reluctant...

What is a Utilization Review or leads to having one? Is it somethng that comes from the insurance company? something that may be related and relevant to W/C? I really do not know.

What I can say or reciprocate with is that I recently received a letter from my insurer about the potential of having a "nurse case manager?"

And... thus... I'm wondering if maybe patients are seeing as you are, and as I am, only the terminology they "utilize" differs.

For all I know, and for now (having not called back the woman who wants to be my "manager'), I could be headed down the road of seeing the same type letter you've received.

Anyway, only share what you feel is okay on the Net - for all the world to possibly read. I know, I definitely won't post info. that can, in any way, hurt my healthcare.

- sorry for any typos; really hard for me, as it is others, to sit and use a keyboard right now -
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Old 09-24-2010, 01:37 PM #3
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T is dealing with Work Comp Utilization Reviews I believe - I don't know if private ins companies do this also or not?
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Bobbi (09-27-2010)
Old 09-28-2010, 04:16 AM #4
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Utiliization Reviews are part of the new work comp laws that came in when Arnold Schwazeneggar supposedly was going to clean up work comp. I even voted for him!

Well, what they've done is that even in admitted cases, if your doctor wants to give you medicine or do a surgery, they put it in their report which goes to the insuranc co. The adjust then sends out a UR from some "junky doctors" to say "patient doesn't need this, refuse immed." Then your doc has to respond again, and your attorney, and then your attorney files for a hearging, and we have to wait for the hearing, then testify and wait for a decision.

In NEVER was intended for medications alone.

Yet this is what they are doing to many of us.

The doctors then get burned out on you, and fire you as a patient...

It is sad, illegal, and in my case, may kill me. If I die, hey, I'm only worth a hundred thousand - but alive, millions over the years.

And what are insurance co. sole object? To squeeze every penney out of the case...

In your case, a case nurse manager is supposed to help and guide you through the injury to the right doctors, surgeries, and recoveries, whatever is right for you.

But you are entirely right. They are not your FRIENDS. Don't "chat" with them cuz EVERYTHING you say will be written down and used against you at some point. If anything happens that starts to look like they are going against you, then you must get an attorney. Even if you don't think your case is work comp, EVERYONE should get a free work comp analysis with an attorney just to make sure you're not giving away rights.

God bless you.
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