by donti32 » Fri Oct 02, 2009 04:38 pm
I was involved in a pretty big accident 5 weeks ago. I was alone in the car. The other driver was ticketed and was found to be at fault. My car suffered $19,000 in damages. The rental car was about $900. The third party spoke to me and clarified that they are 100% at fault and have payed for these repairs. I bought new car seats for $500. I was told they would reimburse me and to keep the receipts.
I was taken to the ER for neck, elbow and shoulder pain. I had two digits with numbness. The x-rays of the neck indicated a possible fracture and was later ruled out with an emergency CT of my neck. The ER diagnosis was cervical radiculopathy. I was told to follow up with my primary in a few days.
My primary physician wanted to let the inflammation cool off for 2 weeks. He prescribed muscle relaxers and anti-inflammatory medication. I was given a note to work at half my capacity for two weeks. After the 2 weeks the numbness subsided but the elbow and shoulder were bad still. The neck was just tender at the end of the day. I was told to get radiographs of the elbow and shoulder and start physical therapy 3x a week for 6 weeks. The x-rays were normal. Again I was told to work at 50% my capacity
At this point it had been a month since the accident. I still had pain in the elbow, which was diagnosed as lateral epicondylitis (tennis elbow) from the impact with the glass window. The shoulder was still bad after 2 weeks of therapy so I consulted with a orthopod. A MRI of the neck and shoulder were done. The shoulder involved a procedure to inject dye into the joint space. The results were yesterday. I have an extensively torn labrum. They want 4 weeks of additional therapy and a follow-up. If I need surgery I will be not able to work for 2 months minimum. Again I was told to work at half my capacity for 4 more weeks.
I cannot be sidelined for two months. My practice will bankrupt. Can I settle, assuming the therapy will help manage the shoulder, for future medical treatment and lost wages? I know because I asked, the 3rd party does not have minimal coverage. I have underins. coverage of 250/500. I want to get feedback and avoid a lawsuit. Lawyers are salivating over this case.
Oh by the way I work 8 hours a day and earn $230 per hour. My employer is keeping track of my lost wages. It adds up to over $5000 per week plus any lost time for therapy, doctors vists, etc. My car is taken care of. I had the car inspected and appraised. It has lost 8-10k in resale value. My doctors bills will be 15k without surgery.
I need to get better but this is starting to get overwhelming.
I was taken to the ER for neck, elbow and shoulder pain. I had two digits with numbness. The x-rays of the neck indicated a possible fracture and was later ruled out with an emergency CT of my neck. The ER diagnosis was cervical radiculopathy. I was told to follow up with my primary in a few days.
My primary physician wanted to let the inflammation cool off for 2 weeks. He prescribed muscle relaxers and anti-inflammatory medication. I was given a note to work at half my capacity for two weeks. After the 2 weeks the numbness subsided but the elbow and shoulder were bad still. The neck was just tender at the end of the day. I was told to get radiographs of the elbow and shoulder and start physical therapy 3x a week for 6 weeks. The x-rays were normal. Again I was told to work at 50% my capacity
At this point it had been a month since the accident. I still had pain in the elbow, which was diagnosed as lateral epicondylitis (tennis elbow) from the impact with the glass window. The shoulder was still bad after 2 weeks of therapy so I consulted with a orthopod. A MRI of the neck and shoulder were done. The shoulder involved a procedure to inject dye into the joint space. The results were yesterday. I have an extensively torn labrum. They want 4 weeks of additional therapy and a follow-up. If I need surgery I will be not able to work for 2 months minimum. Again I was told to work at half my capacity for 4 more weeks.
I cannot be sidelined for two months. My practice will bankrupt. Can I settle, assuming the therapy will help manage the shoulder, for future medical treatment and lost wages? I know because I asked, the 3rd party does not have minimal coverage. I have underins. coverage of 250/500. I want to get feedback and avoid a lawsuit. Lawyers are salivating over this case.
Oh by the way I work 8 hours a day and earn $230 per hour. My employer is keeping track of my lost wages. It adds up to over $5000 per week plus any lost time for therapy, doctors vists, etc. My car is taken care of. I had the car inspected and appraised. It has lost 8-10k in resale value. My doctors bills will be 15k without surgery.
I need to get better but this is starting to get overwhelming.
Posted: Sun Dec 13, 2009 02:49 am Post Subject:
two questions:
1. My UIM sent me a letter indicating it was too premature to offer the policy limits. She is awating more info and a salary/work form from my practice. Should I at this point ask what info and get it for them? Can there be anything done to push he process along?
2. I have a lien attached to the 3rd party settlement. The physical therapist has submitted the bill to my personal health and auto med pay. Med pay payed $900 or so and the rest went to my PPO health insurance deductable. They are not billing my health anymore and have never removed or plan on removing any of the contract PPO fee reduction. By my calcualtion the $8400 lien should be around $2800 if the PPO excess is removed. Any idea on the legality of this. My health insurance is talking to their fraud division and the physical therapist. My idea is to get the settlement checks sent to me and keep the physical therapist portion in a safe until everyone agrees on the law. I understand I will not be able to cash it as it will be in two names. This is what the claims adjuster adviced.
These doctors want full fee. I would love this but I follow my PPO contracts.
Posted: Sun Dec 13, 2009 12:11 pm Post Subject:
Should I at this point ask what info and get it for them? Can there be anything done to push he process along?
Absolutely you can ask what EXACTLY they need so you CAN help move this along.They are not billing my health anymore and have never removed or plan on removing any of the contract PPO fee reduction
Why? They can't pick and chose, to do that if they have a contract..I'd insist that my health carrier pay the bill. then your health carrier will likely subro, (or place a lein) against your settlement but it will be less than this, (gouger IMO)...These doctors want full fee. I would love this but I follow my PPO contracts.
Tough...yes, of course hold on to the money, until this is sorted out...But I'd talk with my PPO, and I'd tell the therapist (in writing) that I want my bills submitted and paid by my PPO, per the contract, and their lein released toot sweet!Posted: Sat Dec 19, 2009 06:13 pm Post Subject:
After a nasty fight I finally got the physical therapist to submit to my insurance. I estimated the bill will be $2500 total not $8400. THey were not happy. I now seek treatment somewhere where they charge me a cash price and I pay as I go. I will keep and submit the receipts. I have asked the third party to cut checks and pay the liens. I suspect the physical therapist will hold things up until the EOB's are all in and calculated.
Posted: Mon Dec 21, 2009 12:42 pm Post Subject:
THey were not happy
TOUGH! and my Grandma used to say, "they can get glad in the same pants they got mad in"I suspect the physical therapist will hold things up
I wouldn't be surprised, one more way to 'get to you' after you won the battle...you know it's people like that, that give others in the field a bad name...just makes you want to knock 'em down a peg...and it appears that you did! good for you! one for the 'good guys'!Posted: Sun Jan 24, 2010 04:46 am Post Subject:
just in case anyone was wondering. I forced the in-network physical therapist to submit to my health insurance first. This took alot of fighting. The ppo adjustment was around 3/4 off. Finally received the checks from the third party at fault insurance for 100k. I am waiting for my UIM to get back to me. As of now my UIM has sent my file to the medical review dept and now is at the settlement authority dept. She also explained that they will be taking the 100k off the UIM as they are allowed to. I hope this is a positive sign that they will come back with the policy limits. ??? One could hope.
Posted: Sun Jan 24, 2010 12:49 pm Post Subject:
I think so....also now Donti, it's entirely possible that your health carrier will slap a lein on this..'if' your policy has subro rights...and I've never seen one that didn't. On the up side you might be able to them into backing off if you can show your loss exceed all coverages..(just a little heads up there:)
Posted: Tue Jan 26, 2010 07:06 pm Post Subject:
thank you. Fortunately my health carrier has only directly payed around $1000. The major savings was from the ppo network write off.
Still waiting for my ins's UIM to get back to me. I was told it is at the claim authority dept. Not sure what that means for the claim. I hope they come back with my demands of the policy limits and not some crazy response.
Posted: Tue Jan 26, 2010 11:21 pm Post Subject:
I was told it is at the claim authority dept. Not sure what that means for the claim
I would assume that means the adjuster has sent it up the ladder for 'authority' to pay "blah blah". If it's any consolation, based on what you have posted (solely), if it were my claim I would recommend policy limits...not that it really matters what I think :wink:Posted: Wed Jan 27, 2010 11:14 pm Post Subject:
I called the adjuster to day to find out "she is no longer with the company." AHHHH!!! Now I need to deal with her manager. Someone please. I am losing my mind!!
Posted: Thu Jan 28, 2010 12:57 am Post Subject:
AHHHH!!! Now I need to deal with her manager. Someone please. I am losing my mind!!
This is probably the absolute best thing that could've happened...managers don't usually "handle" claims, they review them and auth them...This managers authority will be a lot higher than the adjuster...and he/she 'should' be a lot quicker to return calls...hang in there, the end is in sight! :wink:Add your comment