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This entry is part 2 in an ongoing series of semi-irregular posts detailing my frustration with Workers Compensation and the wonderful world of rotator cuff surgery: Part 1 | Part 2 (YOU ARE HERE) | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11
You may remember a post I made last month about how I injured myself in a fall at work. The doctor at the time told me that it was not broken, nor did I have any sort of rotator cuff injury, which were the two things I was most concerned about. I took Ibuprofen and basically went about my normal business, expecting my arm to get better.
Only it didn't.
I mean, it did, but not fully. By the 19th of August, nearly three weeks past the date I had fallen, I went back to my doctor and told him that it still hurt like hell to move my arm in certain ways <insert old joke "Doctor, it hurts when I do this." "Well, don't do that!" <laughter> here>, and that I was getting tired of not being able to use my dominant arm.
I must interject a "rest of the story" point or two, here. The first time I went to the doctor, I did not mention the term "worker's comp" or "on the job injury" or anything of that sort. I fell in the parking lot, it was no one's fault, and, hey, he said it would get better, right? I told my boss about the fall, and he duly reported it to HR. Who reported it to someone else, and they told two friends, and they told two friends, and eventually it made it up to the Office of Homeland Security. Or something. I am fairly sure the NSA was involved. I don't really understand how the whole system works (clearly), but the upshot is I got a call from Some Woman at Some Company who asked me a bunch of questions, expressed skepticism about workers comp paying if the incident took place in the parking lot (unless my company owns the parking lot . . .). She would call me back, she said, if she needed any more information. That was on, like, the same day I posted that earlier post.
So anyhoo, on my second visit on the 19th, my doctor referred me to a physical therapist down the road from his office. I called the number and made an appointment for the next day.
I went early on the morning of the 20th of August and within 5 minutes of having me perform various motions with my joints, the doctor took me over to a large anatomical chart showing the bones, muscles, and tendons of the arm and shoulder, and showed me exactly what I had done to myself. The gist is: tendons. I did bad things to the tendons that hold my upper arm in place so that it doesn't scrape painfully against my shoulder blade when I move it. The whole 'jamming' thing, probably.
He gave me some exercises to do every two hours, some to do twice per day, and sent me on my way.
On my way out, I paused at the desk to schedule my next appointment.
And that is when my tape turned crimson.
It seems that they can't bill workers comp unless they have something written from them, and if they bill my insurance and they find out it happened at work, they won't pay until they have a statement from workers comp that they've denied the claim. So they can't bill anyone unless I get someone to admit that they'll pay for it.
Well, how hard could that be? <----------- If you listen carefully, you can actually hear the sound of my naïveté, here. It sounds like rainbows and fuzzy, baby bunnies and clown noses.
I got the contact information for Some Woman from Some Company that I had given all that information to. I left a message. Her voice mail said to leave my information and she would contact me promptly.
Apparently, "promptly" means entirely different things to me than it does her. To me, it means, "at my earliest convenience." To her, it means, "at some point before the inevitable heat-death of the Universe. Maybe. If I'm not doing anything."
For three solid days, I called multiple times, leaving voice mail after voice mail. Finally, I reached her on day three because she apparently forgot to let the phone go to voice mail. "Oh, yeah, I've been meaning to call you back." Really? Last I checked — repeatedly over several days, in fact — dialing a phone is not all that complicated. "I can't help you until I get a fax from your doctor with the prescription or order or whatever for you to have PT."
I wondered quietly when she had been "meaning" to tell me that there was something I could do to move things forward. But hey, how hard could that be? (Did you hear it that time? Listen carefully for kittens and fluffy baby ducks and the fresh petrichor of new-fallen, summer rain.)
I called my doctor's office and they assured me that they would fax that information over immediately. Well, for values of "immediately" that include "after hours when we do all the office-work." But, you know, great. As long as it gets done.
I let it go for the weekend. The next week was hectic as I was having to work long hours to finish a project before six days of being out of town for WorldCon (report forthcoming). I figured the doctor's office had faxed the thing like they told me, Some Woman at Some Company had gotten it, and was even now doing her job with aplomb and efficiency. (OK, you had to have heard it that time. Clouds and candy and the gentle twang of a salty, ocean breeze.)
I got back from my vacation on Wednesday, September 4th. No voice mail. Interesting. I left Some Woman at Some Company a voice mail. I mean, you know, several voice mails. I'm ashamed to admit that the last one may have mentioned that our definitions of "prompt" were . . . divergent. And I may have had a tone in my voice that conveyed a certain level of annoyance.
The next day, I called two more times and left voice mails. Then I called my doctor. They assured me they had, indeed, faxed the information to the number I gave them.
In desperation, I tweeted Some Company's Twitter account, reasoning that dredging customer service problems into the public arena is the last thing they want. It turns out I was correct. The next day, they gave me a contact email, and I emailed it and gave them a brief synopsis of this narrative. (Y'all are getting the much more entertaining one, I assure you.)
Shortly after I arrived for work on Monday, the 9th, imagine my complete lack of shock to get a personal phone call from Some Woman at Some Company. She was very helpful. It turns out that she had spoken with my doctor's office (who knows when) and discovered that the PT prescription hadn't been digitized, and so had never been sent.
So now the ball was back in my court, again. (That sound you're hearing now is my dawning realization that this is never going to end. It sounds like bubbling tar, the squawking of a chicken as all its feathers are removed, and dead shrimp marinating in ammonia. It's not pleasant.)
Rather than call my doctor's office, I decided to go by there in person and have a word with them face-to-face. Which I did shortly after work. The receptionist I spoke to was very helpful and told me that Some Woman at Some Company had not actually told them what it was she actually needed, actually. I relayed Some Woman's words to them, and they promised me they would fax them post haste.
How hard could — You know what? No. Insert sound of burning forest fire, tortured animals, and rancid blood here.
At the very bitter tail end of yesterday, the 10th, I heard from Some Woman at Some Company again. She happened to call during my potty break, and it was conveniently after their office hours when I got the voice mail. She said my doctor's office lied to me (her exact words) and that what she got was inadequate. They had sent her exactly what she told me she wanted: the prescription for me to go to PT. I mean, how dare they send her exactly what she asked for! The nerve!
All I needed to do was get them to fax her the medical records with the doctor's notes detailing why I was being sent to PT, and what the desired outcome is.
How hard — Oh, fuck it. Tuesday night is my critique night, and I'd just go by there the next morning and talk to them again.
Which I did. When I told the receptionist a carefully edited version (minus the 'lying' accusation) of what Some Woman at Some Company had said, she rolled her eyes. "They always do this," she said.
I then watched while she printed the documentation and faxed it to the number. Then she said, "I know what she will say, next, because they always do this. 'I can't read the doctor's handwriting,' she'll say. 'You need to send me a typed transcript,' she'll say. Ugh!"
That sound you're now hearing is the hollow ringing of a cold, bitter wind blowing through the gaping hole where my faith in humanity once dwelt. It was warm back when I still had it. Now? I'm not even cold. Numb, perhaps.
So, to sum up: It's now been six weeks since I fell. I've had one PT appointment. I can't schedule more until someone, somewhere, does a job. Maybe not even their own job, just someone's job. I'd settle for a janitor at this point. Just send me something saying "no" so I can get my insurance to cover it.
<sigh> Does anyone hear me? Is anyone out there?
<small voice> hello?
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Kathy
http://gigglingtruckerswife.blogspot.com
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And yeah, they always do that. My assumption is they're hoping you just give up. I bet a lot of people do.
My wife has new insurance, and now every time -- every time -- a claim is sent to them, they send her a letter saying they hope someone other than them will pay this, and she has to answer all sorts of questions ("Are you sure you can't sue anyone over this? How about Workman's Comp? Will Workman's Comp cover your heart irregularities?"), and if she doesn't answer them all they'll just reject her claim right now.
It's also not just you.
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I told them if they could prove it go for it.
What a nightmare.
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Crazy Red Tape!
Re: Crazy Red Tape!
Re: Crazy Red Tape!
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It has been over a month since filing my short term disability.
I know EXACTLY the kind of hell you are referring to. At least I got care, this is just for pay now.
After sending in gobs of paperwork, I get another form to fill out listing all doctors, hospitals, rx, everything. I was told to,complete it for the time I was injured.
Two weeks later, no, they need that filled out for three months before I started work at my new job. Because it may be a pre existing condition. Omg. Filled out again. A another week and I call again to check on the status and I'm informed then that when they contacted the pharmacy for records, when they got back to them they said it would be a month or longer to get them sent. WTF. I told her I could pull it from the website and have it in ten minutes tops.
Got it, sent it, not a peep yet. Calling tomorrow to check again. They will probably want something I don't want to guess.
Pain. I feels it for you. But you should be able to get care now!
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Our workplace has made it mandatory to call a super seekrit phone number as soon as you are injured at work. and if you don't happen to have the card upon which the super seekrit phone number is written in teetiny numbers, then no medical care for you.
"just don't get hurt at work, buddy, you can be sick and or dead on your OWN time!"
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Dueling Insurances
On the one hand, this is a great arrangement because after your primary insurance pays its percentage of a claim, the secondary will pay some or all of the remainder. Our premiums were higher, but our coverage was fantastic.
On the other hand, both insurances refused to pay a red cent until they had proof that the other insurance had denied the claim... and sometimes they would refuse to even admit they had denied the claim, which as you can imagine is frustrating when you need proof of denial before the other insurance company will move.
On the gripping hand, Liz worked in the billing office of a health insurance company, and has a psyche made up of equal parts courage, OCD, and sheer bloodymindedness. She worked out exactly the magic sequence of triggers and events to get either or both companies to pay our claims. Then again, it sometimes took up to ten weeks to actually get claims paid, and it *always* took a minimum of three weeks. (Submit to secondary, get denial, submit to primary, get partial payment, resubmit to secondary, get remainder.) We also had to pay cash for everything up front and get reimbursed later, because no doctor's office could navigate the billing maze. (Which we found out by being threatened with getting sent to collections for bills we thought were paid.)
A few years and some freelancing later, I had obtained private health insurance through NASE, which was handy since I tended to work hourly or at small companies that didn't offer insurance. The company I was at decided to offer group insurance, and when I abstained, it put the company one person under the magic number to get a price break on insurance. I got called into the VP of HR's office, where I was informed that I would be enrolling for the company's health insurance plan. I told the VP that, no, in very much point of fact, I would not. I explained the dual-insurance nightmare, and that I wasn't about to drop my current insurance. I believe the exact words I used about their insurance were "Not now, not ever, not any way in hell."
In theory the VP really should have asked why and how, but all he could see was an employee refusing a direct command from a VP, so he shouted "All employees have to enroll! You don't have a choice!"
I grinned and said "Wanna bet?"
"Yeah!"
"Fine. I quit. Fuck you, fuck your insurance, and fuck you again. I win."
The best part was giving a chipper "Good morning, Mike!" to the VP of HR the next morning as I reported for work at my new job. Same office, same project, same company--but as a 10-99 contractor. Turns out that when you turn a disastrous project around and save the company, the President of the company will personally intervene--and negotiate quite flexibly--when you try to quit. :-)