First, have a listen at my first attempt to contact the “chiropractor” that denied my surgeon’s treatment request; followed by the last call with his receptionist.
Yes, I’m as confident as you they’ll be calling back. Then again, I’m overly optimistic and naïve. PS: Don’t ask me what’s going on with the first guy, but damn it’s funny. Feel free to call him at (954) 720-1040 to find out.
Some of you know that I was severely injured on the set of a TV show back in September of 2010. Torn meniscus and some other stuff I can’t spell in the knee, and a busted up ankle. The workman’s comp insurance company, Broadspire, is doing a fantastic job…for their investors. An amazing job in trying to not pay for anything.
Unfortunately, for them, there’s lawyer in the family and a couple of well-placed referrals later, my stress was passed to my new lawyer. Suddenly I was scheduled for knee surgery with a top LA knee doc. Of course, by “suddenly”, I mean 9 months later.
Surgery went well, and I am getting much better. The standard physical therapy treatment after this kind of surgery is usually 12 visits. Broadspire approved 6. And the game is to go back to your physician and have them request 6 more. Back-and-fourth they go: request? Deny! Request? Deny! Request? Ok. And all while the patient waits patiently.
Here’s where it gets somewhat interesting.
California law allows health insurance companies under workman’s comp claims to have their own “physician” create a diagnosis of you, the patient. This “physician” never actually sees you, only reads the medical reports, is paid by the insurance companies, and is their job to give a “doesn’t need it” denial response. I got several of these counter reports throughout the 9 months while Broadspire simply didn’t want to do the right thing and pay for the necessary MRI, surgery, treatments… and now, physical therapy.
We get it. You’re an insurance company. Your job is to make money. Got it. Doesn’t mean can’t call you on your shit tho.
So, in this most recent denial, it reads: “Determination was based on Bruce Mark, D.C.’s review of a prescription for physical therapy.” Meaning, some dude read a letter from my surgeon who asked for 6 more physical therapy visits, and then concluded that “the request is not medically necessary.”
Interesting, since I’ve never met Bruce Mark, D.C.
Let’s track him down and inquire as to how he came to this conclusion without actually seeing me, knowing anything about me let alone what I may or may not need for my knee/work/life. Hell, I could be a knee model, right?
A quick Google of his name, and we’re looking at a Chiropractor somewhere in Florida. Yep. Florida. Lot’s of great chiropractors there I’m sure. I made 4 calls to find him (you heard two of the 4 above), and wouldn’t you know it… no call back.
My lawyer reminded me most of the physicians that are hired by insurance companies to deny request no longer actually practice medicine, and in some cases, don’t exist. Neat. I want that gig.
So, what did we learn today?
1. Always lawyer-up in workman’s comp.
2. Insurance companies have indeed worked hard to earn the disrespect and ass-fucking they so deserve when legal action is brought upon them.
And what did the insurance company learn?
1. Probably nothing.
But, you know, if Broadspire did the right thing in the first place, I might not have had to get a lawyer period. Just something for insurance types to think about.