The Workers Com Matrix

Despite of all the feeling nothing kinda bullshit I have been talking about all these times, I am now reaching a point when I can blow off when things have gone far enough.

So, I have been waiting to get back to receive physical therapy for my back since November 2008 after the workers com insurance company denied the authorization for all treatments based on the report of the Independent Medical Examiner (IME).

After my first court date in January, I had to wait for a long time till finally the physical therapy place had a slot for me for an appointment.

Unfortunately, I was not able to make that appointment because of the following three reasons:

1. I missed my orthopaedics doctor's appointment on February 12th, 2008 because I went to the ER to rest my head and body
2. The physical therapy place would not be able to see me because they said I needed a new prescription from the orthopaedics doctor
3. My next appointment with the orthopaedics doctor was supposed to be in late February

The day I got discharged from the Cuckoo's nest, I went to the office of the orthopaedics doctor and made sure I got the prescription for physical therapy.

It took me 2 weeks to finally get to an appointment. Yet, when waiting, this lady came in saying something like, "she failed IME and she is only authorized be treated for her knee."

So, OK, I was being treated for my knees for 2 sessions until Workers' Com insurance denied the authorization for all my treatment again.

All that I could do is to wait for the court day to come again and try to do my ordinary stretching and exercise routines.

The court day finally came again where there was the ruling that I should continue to receive benefits such as treatment.

When I call up the physical therapy place, they indicated they won't be able to see me until the workers com gives them documentations indicating my treatment is authorized.

I waited and waited till the letter from the court arrived...

I called back to the physical therapy place; yet, they still insist my treatments were not authorized and they needed a letter from workers' com despite the court order.

So, I called the Workers' Com Board and the person who spoke with us said no one needs no letter from them. Maybe I shall contact my adjuster directly.

I called the insurance company and spoke with my adjuster. She indicated that she had authorized the treatment and forwarded the documentations and would do it again immediately.

I called back to the physical therapy place, which still insisted on having no record of receiving anything from the insurance company while, later same day, I got a phone call from the physical therapy place stating now it was possible for me to get an appointment (last Thursday).

Today, I called back to the physical therapy place to make an appointment for the initial evaluation for treatment on my back. I was told again that the authorization was only given to my knee although what I really need is treatment for my back.

So, again, I tried to call the adjuster and could not get a hold of her.

I tried again and she was still busy.

Yet, this time, the person answered the phone asked me what my call was concerning about.

I told him that the physical therapy place said the insurance only authorized treatment to my knee but the court order said I could receive treatment and the adjuster told me the back is also an option.

This round, the workers com receptionist told me, "The doctor's office did not request treatment for the back; only for the knee."

So, I thought it might have something to do with my orthopaedics doctor's office and called them up. The lady answered the phone told me-- the "doctor's office" in this context meant "the physical therapist' office."

I called back again to this physical therapy place.

The lady answered the phone again swore that my authorization for back was denied.

I told them again that the court order in March said I am again entitled for treatment and I spoke with my adjuster who indicated I could receive treatment on my back if I elect to. The problem was that their office sent in the request for therapy on the knee rather than on my back although what the prescription of the doctor indicated treatment on neck, back and knees.

Then, this lady I was speaking with said-- that was sent in by our corporate office... and we just kept on going in circle not going anywhere... 8-O

Then, I guess it was the manager who came to answer the phone... we went through the whole thing again...

She again mentioned that I failed the IME report and the authorization for the back treatment was denied.

I told her the ruling for March again but she didn't seem to care.... and kept on talking about the denial of authorization.

Finally, I asked her when the authorization to the back was denied, she told me... "November."

I repeated myself again... BUT THE RULING OF THE COURT THIS TIME IS IN MARCH AND THE ADJUSTER SAID I COULD HAVE MY TREATMENT TO THE BACK and your office is the one that requested for the treatment on the knee rather than what I am asking for-- my back. (Which part of common sense don't you understand?)

This manager continue to insist on me getting a letter from the adjuster stating the length and the number of sessions I am entitled to... and blah blah blah...

I finally could not and did not want to hold this any more... "Do you make it so difficult to all your patients?"

Yet, at that point, I realized something...

Controlling for all other parties, this place has been making it really difficult for me to get back to therapy.

Possibly, they are really well to do and they don't care whether they have patients or not.

Possibly, they feel they are doing the beneficiaries of workers com a favor because not all places accept workers' com insurance.

I had not decided to switch place because this place is close and they already have my info on file.

However, I thought to myself... sometimes, enough is enough...

The next available appointment for evaluation would be on April 16th and, possibly, I won't be able to get appointments for my real therapy session for a week or so.

By that time, I will be getting ready to go home to receive a combination of Eastern and Western treatments without having to deal with all these BS or, else, I would just look for another place in town.

While the lady on the other side of the line was still going on with the same old tune, yours very rude said something like this to her, "Do you make it so difficult for everyone? This is awful. I don't need it. Thank you. Bye." And, I hang up the phone.

In addition, I didn't fail IME. Rather, I think it is the IME failed humanity and me.

It was awful for me to hang up on people.

However, it felt actually very good because it was almost like I finally decided to get out of an abusive relationship that I could not let go of....

In addition, when I went out to calm myself down with that cigarette of mine, it occurred to me again... I could not be along and there are, have been, may be many other people to be in the same boat....

For about 5 months now, I am still fighting to get back to physical therapy for my back and does anyone wonder why the recovery rate is so very slow?