Workers Comp 6: Return of Evil Second-Cousin of Workers Comp

[kaasirpent]

  by  wstera2 

This entry is part 6 in an ongoing series of semi-irregular posts detailing my frustration with Workers Compensation and the wonderful world of rotator cuff surgery. In case you haven't been keeping up: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 (YOU ARE HERE) | Part 7 | Part 8 | Part 9 | Part 10 | Part 11

You knew there was going to be another part, didn't you? I certainly did. Because why should anything be over when it's over?

So, first things first: Story time!

<insert flashback effect here>

Picture it: Eutaw, Alabama, ca. 1979, sometime in the spring. Or fall. Or maybe winter . . . The point is, I was in the 8th grade.

Interior: a typical school gym. Two grades of kids (8th and 7th) are in P. E. together because no one class is large enough to have, you know, actual teams. Today's activity: WARBALL.

For those not in the know, warball is basically psycho team dodgeball with lots of balls, and each person who gets knocked out joins the team of people hurling many, many soccer or dodgeballs into the center, trying to knock out anyone who's left. I remember it being both girls and boys, but I could be wrong.

I got knocked out fairly early on, and was gamely hurling balls at my classmates and underclassfolk. A ball exited the center and I ran for it. Unbeknownst to me, so did Darren. I caught the ball just as it bounced off the gym wall . . . just in time to be body-slammed by Darren up against the wall of the gym. I heard and felt something . . . *click* . . . in my right big toe.

It hurt like heck (I didn't use words like 'hell' back then). I went into the locker room and took off my shoe and sock and was cradling my foot when Coach Lolly walked in, because he had seen me limping off the court. He asked what was wrong. I told him what had happened, and said, "I think it might be broken." He said, "It's just jammed. Get back out there."

I didn't. I continued to nurse my foot, much to his disgust, I'm sure. After class, I told the 8th grade homeroom teacher, Mrs. Davenport, that I had hurt my foot and needed to call my parents. She sent me to the office to do so. Well, the coach had told the principal (Mr. Clayton? Preacher Don? I don't remember who it was at this point.) his diagnosis, and he was unmoved. So I limped around on my toe all day. It hurt like heck and a half (I didn't use words like 'shit' back then).

My grandparents picked me up after school, but I had an orthodontist appointment in Tuscaloosa. After that, I got my hair cut at McFarland mall. All this time, limping on my foot that hurt like heck squared (I didn't use words like 'fuck' back then).

I don't remember whether it was the next day or not, but at any rate, I ended up at the doctor. Dr. Joe Bethany, who had been my doctor since before birth. He said, "It's probably just sprained," or something non-committal. I begged him to x-ray it, because it continued to hurt like a mother-fucker (I didn't use those words back then, but I should have).

He reluctantly x-rayed my foot. And developed the film. And put it up on the light box.

And from all the way across the goddamned room, I could see the break. I said, "So it is broken."

He said — and I will never forget this — "Hmmm. There's a suspicious line."

I said, "It's broken, isn't it?"

To make a long story slightly less long, I had broken my toe. Well, technically, Darren had broken my toe. Daddy went to the school to have a little chat with the coach. My mother tackled the principal. Not literally. But he probably wished she had by the time she was done with him.

<insert flashback-ending effect here>

Why did I tell that story? It will soon become obvious.

So. Back in October, we left our intrepid hero (me) with physical therapy appointments, finally. After a long, drawn out battle. I had my first six PT appointments. They seemed to help. I had a lot of exercises to do, and they all hurt like heck. But I did them.

And after six visits, it still hurt like heck, but there was a bit more mobility. But Some Company had approved "eight to ten," so we still had a little wiggle room. So we scheduled six more, and I went back to my doctor to get another order for PT, which he gladly gave me.

Fast forward to the tenth PT visit. Melissa told me that Some Company had told them they weren't paying for any more visits after the sixth one, because they had only approved eight to ten. (Don't think about this too long. I did, and I lost 7 IQ points, permanently. But I still remember Gilligan's Island episodes. Can't ever get rid of something that doesn't matter. But I digress.)

I pointed out that they had said "eight to ten," and that six is not equal to either eight or ten, based on my many years of mathematics. I mean, I'm not a nuclear physicist, but this is fairly easy math. But apparently not for Some Company.

We cancelled my last two appointments until they could straighten everything out, and Melissa said they had also sent in my doctor's request for six more.

I spoke to Jane in HR about the whole thing, and she once again got everyone involved, and Some Company said that they would, indeed, pay for ten full visits. Once we explained the math to them. And I don't even mean that facetiously. Jane had to actually say, "You said 'eight to ten,' and he had six, after which you refused to pay for any more. Six is not 'eight to ten.' He's had four more, and by your own agreement, you should pay for them."

But still nothing about the approval for the remaining ones my doctor felt were needed.

Then I got The Letter. <ominous chord>

In The Letter <ominous chord>, I was informed that a doctor I have never met in my life reviewed my case and decided that since I "had returned to work at full duty" (which I never left, I might add), further therapy was "not medically necessary," and that they would not be covering the last two visits, nor would they be covering any subsequent visits. Further, my case was closed, and that was the end of it, as far as Some Company was concerned.

I . . . might have exploded. All over anyone in audible distance. I . . . might have used some of those words I didn't use in 8th grade. I might, indeed, have invented a few new ones. And I might have marched, letter in hand, to HR.

The next email from HR — after Jane talked with Some Company and others — was that Some Company would be paying for the final two visits. They I would request my PT for a referral to an orthopedist. And we would go from there.

So, I asked the PT for a referral.

Crickets. When I finally got hold of them again (another week went by because I thought maybe they were mailing it), they said they didn't do that, and that Melissa was no longer employed there, and who was I again? I would have to talk with my regular doctor.

I went a few rounds on the phone with his office staff, as well, and basically found out that I can't trust his office staff to give him messages.

Finally, in frustration, I contacted HR again and got them to send me a list of 'approved' orthopedists. I picked one and made my own damned appointment.

Which was yesterday at 3 pm.

The first question he asked me was, "Has your elbow been x-rayed?" I said it had not. He made some remark under his breath that I didn't quite catch, and then sent me to get an x-ray.

They x-rayed my elbow. And developed the film. And put it up on the light box.

And from all the way across the goddamned room, I could see . . . something.

He called me closer. "Do you see this little dark line right here?" He pointed. I said I did. "That is the sign of a healed compression fracture. That's why your elbow has been hurting."

He said that fractures like this "always heal" and that the treatment is basically to keep using it as normal so you get full movement once it heals. But it would continue to hurt for 3 to 12 months. I assured him that I had been using the arm as normally as I could given the pain. He said that was good.

Well, that's nice to know.

He then wanted to schedule me for an MRI of my shoulder. Which meant I had to call Some Woman at Some Company and get that approved. I called, and it went directly to her voice mail.

Much amaze. So expect. Wow. I didn't even bother leaving a message.

A few minutes later, as I was checking out and the receptionist was getting ready to call Some Woman themselves, my cell phone rang. It was Some Woman! OMG! First call I've ever gotten back! Alas, I was so shocked that she had called me that I didn't manage to answer. But we knew she was at her desk. So the receptionist ("Martha") called her and got on the phone with her!

The conversation, edited to remove the back-and-forth between me and the receptionist, went something like this:

Receptionist: Hi, this is Martha at Orthopedists R Us. I have one of your clients in my office, and we need to schedule an MRI for him. . . . [Kaa] . . . his right shoulder. . . . He made the appointment himself; there was no referral. . . . He says he got our name from a list of approved medical professionals from his workers comp representative at work. . . . Martha . . . Orthopedists R Us. . . . [Kaa] . . . his right shoulder . . .

And it went on. Then, Some Woman apparently said she'd have to call back and let them know where to send me for the MRI.

Martha said she would let me know if and when Some Woman called her back. [I should note here, for the record, that the doctor and the nurse and the receptionist were all scandalized when I told them about the sixty days Some Company made me wait before getting PT. Apparently, that is not normal. My mishandling of the initial doctor visit is probably what it all stems from. Had I gone to an orthopedist from the get-go . . . but hindsight is 20/20.]

That was yesterday at 4 pm.

Another part of Jane's email from work says this: "Katie (the My Company workers comp program manager) will oversee / ensure that Some Woman is facilitating the approval in a timely manner."

What that said to me was that someone is now watching over Some Company and Some Woman in particular, and that I may finally get some reaction from them on a timely enough basis to do something about.

What? Why are you laughing? That's not very polite.