Dedicated_Dad
junior member
I am just floored. I got the letter today from my insurer - they cut me off May 15 - in other words, at just past 9 weeks.
Some of what the letter claimed were outright lies. He claimed he'd not rec'd any of my PT records, when my PT is in my Docs office, all records are electronic and all were sent. Further, he claims he contacted them (not noting that Doc and PT share a practice-name and phone number) to request records and received a note from them saying they had no such records. Lie, Lie, Lie.
Their main excuse was a cherry-picked quote from my May 15 visit, wherein Doc said I was "improving" and ROM was "about 120." This must have been a typo, as all my PT records from before and after put me under/around 100 under "agressive, passive ROM."
In either case, they totally ignored the rest of what he said on that date:
"...Pt. cannot be released to return to work, he is unable to perform any job duties and will remain fully disabled for at least six (6) more weeks..."
I don't know about anywhere else, but in most cases employers will not allow you to return to work after any disability without a "medical release" from your Doc. Even if I'd wished to go back at ~9.5 weeks (as if I were anything close to capable - NOT!) I'd have been refused.
I had serious muscle atrophy pre-surgery, and was not able to have a quad-sparing surgery. I was still on crutches past 12 weeks and couldn't do a leg-raise until sometime in July.
As it is, I am to see "SuperDoc" and a surgeon next week to determine when I'll be having surgery to correct the "clunk" and will be laid-up for AT LEAST another 3 months.
Worst of all, though there's an appeal process, it appears that Fed law (ERISA) gives these thieves the right to screw me over with impunity. The worst that can happen to them if I sue is they'll be forced to pay what they owe, not a penny more. No interest, no penalty, no Atty. Fees, NOTHING but exactly what they owe. No Atty. will take the case as it's not enough cash to be worth their effort.
So, here I am, on August 15, just finding out that I was financially screwed three full months ago, that I can "appeal" but they'll probably rubber-stamp it with a big red "no" because they can get away with it, and there's basically nothing I can do about it.
This, while I lay on bed-rest ordered by one of the top Ortho surgeons on the planet. I just finished reading his CV - literally 200 pages of articles, books and etc. - but this non-Dr. thief can override his judgement?
I paid premiums for this coverage for 5 years, and just now find out that since I got it through my employer there's nothing I can do. If I'd bought the same policy direct I could go after them in state-court and all sorts of punitive and compensatory damages would apply. As a result, they tiptoe around "private" policies and ride rough-shod over the rest who have employer/group policies... They have every incentive to literally rob cripples, and nothing whatsoever to fear from doing so.
This is insanity. I don't know how I am going to pay my mortgage (14 days overdue) much less my med. ins. premium which is also overdue.
Years of working 90+ hours a week, running myself into the ground, making all my payments on time (FICO score 800+) and paying premiums on disability coverage to ensure I wouldn't ruin it all... I took a paycut 5 years ago to work for this Co. in large part because of the disability policy, yet they're still able to screw me like this.
Best of all, Congress has known about this "loophole" for years, could easily fix it, but will not because of the power of the insurance lobby.
Please be warned: If your disability insurance coverage is through your employer, you could be in the same boat. The only ones that are remotely reliable are private, non-group plans.
This will take 60-120 days minimum just to get through an appeal - about as long as it will take to do the other surger(y/ies) I need and get me back to work. Of course, my home will be in foreclosure by then, and I won't have insurance to cover the needed surgeries, but .... And this is the BEST-case, assuming they don't deny my appeal and finally decide to pay me.
I just can't get over this. I swear, when this is over I will publish every detail on the 'net and do my best to ruin their business through any means necessary.
Un-freaking-real...
DD
Some of what the letter claimed were outright lies. He claimed he'd not rec'd any of my PT records, when my PT is in my Docs office, all records are electronic and all were sent. Further, he claims he contacted them (not noting that Doc and PT share a practice-name and phone number) to request records and received a note from them saying they had no such records. Lie, Lie, Lie.
Their main excuse was a cherry-picked quote from my May 15 visit, wherein Doc said I was "improving" and ROM was "about 120." This must have been a typo, as all my PT records from before and after put me under/around 100 under "agressive, passive ROM."
In either case, they totally ignored the rest of what he said on that date:
"...Pt. cannot be released to return to work, he is unable to perform any job duties and will remain fully disabled for at least six (6) more weeks..."
I don't know about anywhere else, but in most cases employers will not allow you to return to work after any disability without a "medical release" from your Doc. Even if I'd wished to go back at ~9.5 weeks (as if I were anything close to capable - NOT!) I'd have been refused.
I had serious muscle atrophy pre-surgery, and was not able to have a quad-sparing surgery. I was still on crutches past 12 weeks and couldn't do a leg-raise until sometime in July.
As it is, I am to see "SuperDoc" and a surgeon next week to determine when I'll be having surgery to correct the "clunk" and will be laid-up for AT LEAST another 3 months.
Worst of all, though there's an appeal process, it appears that Fed law (ERISA) gives these thieves the right to screw me over with impunity. The worst that can happen to them if I sue is they'll be forced to pay what they owe, not a penny more. No interest, no penalty, no Atty. Fees, NOTHING but exactly what they owe. No Atty. will take the case as it's not enough cash to be worth their effort.
So, here I am, on August 15, just finding out that I was financially screwed three full months ago, that I can "appeal" but they'll probably rubber-stamp it with a big red "no" because they can get away with it, and there's basically nothing I can do about it.
This, while I lay on bed-rest ordered by one of the top Ortho surgeons on the planet. I just finished reading his CV - literally 200 pages of articles, books and etc. - but this non-Dr. thief can override his judgement?
I paid premiums for this coverage for 5 years, and just now find out that since I got it through my employer there's nothing I can do. If I'd bought the same policy direct I could go after them in state-court and all sorts of punitive and compensatory damages would apply. As a result, they tiptoe around "private" policies and ride rough-shod over the rest who have employer/group policies... They have every incentive to literally rob cripples, and nothing whatsoever to fear from doing so.
This is insanity. I don't know how I am going to pay my mortgage (14 days overdue) much less my med. ins. premium which is also overdue.
Years of working 90+ hours a week, running myself into the ground, making all my payments on time (FICO score 800+) and paying premiums on disability coverage to ensure I wouldn't ruin it all... I took a paycut 5 years ago to work for this Co. in large part because of the disability policy, yet they're still able to screw me like this.
Best of all, Congress has known about this "loophole" for years, could easily fix it, but will not because of the power of the insurance lobby.
Please be warned: If your disability insurance coverage is through your employer, you could be in the same boat. The only ones that are remotely reliable are private, non-group plans.
This will take 60-120 days minimum just to get through an appeal - about as long as it will take to do the other surger(y/ies) I need and get me back to work. Of course, my home will be in foreclosure by then, and I won't have insurance to cover the needed surgeries, but .... And this is the BEST-case, assuming they don't deny my appeal and finally decide to pay me.
I just can't get over this. I swear, when this is over I will publish every detail on the 'net and do my best to ruin their business through any means necessary.
Un-freaking-real...
DD