I really don’t get it.  Ok, I understand, they are an insurance company, and the only way they make money is by not actually paying out on claims, but seriously.  Weeks ago I went to the Orthopedist for a follow-up after I had the MRI.  If you didn’t already read about that saga, you might want to read this post and this post.  At that follow-up the doctor prescribed and gave me a brace for my knee.  It is specially designed to help hold things in the right place.  When I say prescribed, I mean that I literally have a copy of the scrip in my folder of paperwork for this injury.

Well, I got home last night (after over an hour of wasted time at the theatre) and opened the mail to find a bill from the supplier of the brace.  This was an actual bill, not just a statement saying that things had been taken care of.  Since I received the bill I was at first thinking that WCF must have denied that claim.  This seemed a little strange to me as they had not notified me of the fact that that was the case.  Since one of the first things that WCF sent me upon filing my case was a prescription card, it seemed very strange to me that this prescription would be denied.  I mean, in the grand scheme of things, the brace is significantly less expensive than many pharmaceutical prescriptions so why would this be denied.

Then it occurred to me that since I had heard nothing from WCF about this claim being denied that I really have actually no idea if the supplier even contacted WCF to event try to get them to pay.  So, despite the late hour and all the other things that I have been dealing with (like planning a wedding) I sat down to write to both WCF and the medical supplier.

I have come to two conclusions which I outlined in the emails both ending with the fact that I am not going to pay this bill until some of my questions get answered.  I conclude that WCF needs to actually tell me that this claim was denied and must do so for any future claims.  I also conclude that I have no proof that the supplier talked to WCF at all.  Therefore I won’t pay without further information.  As I said before, I don’t see any reason why this would be denied at all.

There is one other thing that I outlined in my email to WCF, and that is that if the claim was actually denied, it an be submitted to my personal insurance.  However, I can’t make that claim to my insurance without proof of denial.  Also, I don’t want to have to deal with anyone else, so I want the WCF people to deal with talking to my insurance.  Since this case is supposed to fall under their purview I shouldn’t have to be the one stuck in the middle.  I don’t have the time or the patience for it.  Besides, it is what these people are paid to do, fight with eachother over money, I have more important things to deal with.

Needless to say, I am sick of bureaucracy standing in the way of my recovery.  I would just like to be able to walk without limping or hobbling and I would like to it to be comfortable to bend my knee.  It is such a great thing that our healthcare system works

So, I finally had my MRI this past Monday.  That was much less exciting than I thought it would be, though it is still pretty cool.  Laying still for each of the scans is bloody difficult, and it doesn’t really help when the technician reminds you.  I almost ended up with a pretty good cramp in my leg as I realized that what I was doing was tensing all the muscles in my leg.  Of course when i realized that in the middle of a scan I didn’t think I should really relax since that would probably cause motion in the scan.  A very interesting experience.

I had the follow-up appointment with my doctor this morning to go over the images from the scans.  This was kind of a “mixed blessing” diagnosis.  I suppose the good news is that there didn’t appear to be any damage to my meniscus or any of the ligaments which means that there is no call for surgery at the moment.  He did see a small spot on the scan that he thought was too small to be a problem and it only barely showed on two slices, so it didn’t seem to be worth going after surgically at this point.

On the other hand, what he did see (and hadn’t been able to feel due to swelling) was that my patella (kneecap) is not tracking properly.  In fancy medical terms it is patellar subluxation of the left knee.  The treatment for this includes a funky new brace that is supposed to help actually keep the patella where it is supposed to be as well as 4-6 weeks of physical therapy.  IN the hours since the visit to the doctor and wearing the new brace I have already started to feel a difference.  I am sure that the fact that the swelling has finally started to go down makes a big difference as well.

So, I spent a lot of time psyching myself up/out over surgery and at least for now I don’t need any.  This is a good thing.  It seems like there is a light at the end of the tunnel, and maybe even hope to get some skiing in this season.  We shall see how it all goes.  The fact that the swelling and pain are going down is a really nice thing!

So, if you follow mw on twitter you may have noticed a couple tweets about my dealings/frustrations with Workers Compensation (WCF) regarding my injured knee.  Here is the scoop.  As I mentioned in a previous post, I injured my knee at work on the day after Thanksgiving.  It has been a real bummer since then.  After my initial visit to the doctor, he wanted to get an MRI to determine what is really wrong.  Well, WCF has spent the past two-and-a-half weeks “reviewing” my case.

During that time I have been limping around with an OTC knee brace basically undiagnosed let alone treated.  Last week I had been doing OK, but when I got up on Monday I didn’t feel as good as I had been.  not sure what I did (if anything), but I was getting the feeling that I certainly wasn’t getting any better!  So, I spent a good portion of the day on the phone with the doctor, WCF, and my personal insurance.

WCF had my claim wrapped up in bureaucratic red-tape and there I was, not being able to move forward.  At this point, after being on the phone all afternoon I wrote an email to the WCF people outlining my disappointment with the way my case was being handled.  My personal insurance said that in such a case they would cover me (less any applicable deductibles and co-pay) even though it happened at work.  They said that I should go ahead and get treated and then if WCF came through we could get reimbursed.

As I was about to go through with this line of procedure, I got an email from WCF saying that they wanted to schedule a follow-up appointment with my doctor before they gave the OK for the MRI.  By the time I got to calling the doctor’s office to schedule this appointment, they had already talked to WCF and told them that they wouldn’t be able to schedule me until next week sometime.  At that point WCF caved and just OKed the MRI.  They then called to tell me this after I had learned it from the doctor.  They also informed me that their company would contact me to schedule it.

Well, after a day of waiting for them to call, it seemed like it was not worth the time.  So, I sent another email to WCF, and what do you know, when you get mad enough and threaten to slap an insurance company with more bills they get their act together.  I told them that If I didn’t have an appointment scheduled by the end of friday that I would do it myself and they could foot the bill.  Well, within minutes I had the number and information I needed to call their company and set up my appointment.  Go figure that they actually used the imaging people that the doctor wanted!

So, We are finally moving forward with finding out what is wrong and fixing my knee.  I am sick of dealing with the insurance people, but now that I understand how to motivate them hopefully things will keep moving.  I will finally (after 3 weeks) get the MRI that I need and even have the followup appointment to get the diagnosis.  I may not get the knee fixed by the holidays, but hopefully I will at least have whatever I need scheduled.