Hoops Hoops and More Hoops

Well we have been authentic all along on here so why should this post be any different.  The insurance company representing my claim is trying to remove themselves from everything altogether.  Anyone who has been subjected to an "Independent Medical Exam" ever in your life, know that the exam (which really isn't an exam at all)has a predetermined outcome paid for by the Insurance Company to benefit the Insurance Company's best financial interests.

To the insurance company we are all about the bottom dollar.  It doesn't matter if you are still broken, struggling, unhealed, or not - they don't really care.

Case In Point I received a referral to an Orthopedic Repair Surgeon for my nonunion scapula on April 30, 2015 from my Orthopedic Rib Surgeon who plated my ribs in October 2014. The insurance company said to schedule more appointments locally with random Surgeons (not trained in that kind of repair) just to get "denials to establish need to go to specialist"...so I jumped through those hoops for 4 months.  Then I was told my Primary Care Physician had to search for a surgeon across the entire State.  She sent me to UofM (University of Michigan).  They wrote a letter stating that they don't do Scapula repair surgeries and referred me through my PCP to the same specialist that my Orthopedic Surgeon referred me to out of State.  So by August 2015 I had received THREE referrals to this Specialist out of State to fix my Scapula.  Insurance kept saying that if I jumped through each of their hoops that they would approve a Consultation by said Specialist.

Guess what?  When I scheduled the Consultation....Insurance said we will get back to you by Friday about that.  Friday came and went.  I then scheduled it myself (the consultation ....and by phone even... to save money). I had the consultation with the Surgeon and we FedEx'd him all my Radiology reports and various records and images.  He was phenomenal to speak with and offered an abundant amount of hope to us about my proposed recovery potential.  This was nothing short of exciting.  

All of a sudden I was not getting calls back from the insurance company....and absolutely no response to my emails either.  No responses to my Medical Case Manager either from the Insurance Company.  Then I get this letter wanting me to attend 3 IME's.  That whole experience was a nightmare.  The Transportation they set up was a whole other story entirely.  

Then the IME doctor asks me why I was sent to him since the man I was referred to was clearly the best person for the job to repair my injury.  The IME Dr. even said that I would remain disabled without the surgery....something that the Surgeon Specialist also said.  I was encouraged because their opinions actually matched.  The IME reports ALL had inaccuracies in them once we finally got them last week.  I still am in the process of responding to all the line item mistakes in them.  Even listing me as Right handed, when indeed I am Left Handed.  The one that came the closest to accuracies was the Ortho guy, but even his had mistakes and made me wonder if he even looked at the paperwork I filled out for him or the rest of them for that matter.

Then the letter from Insurance cutting me off from everything entirely even from my Medical Case Manager.  The letter is quite absurd.  I won't go into all of it here and now....though I might not be able to resist.  Now, I work to fight for my life with the very company who one would think would be encouraging rehabilitation but rather hampered it and essentially has stopped it altogether.  At first he said no surgery would be approved....then he changed his stance.....then changed it again and again.  Needless to say they rarely respond in writing and I don't feel comfortable speaking on the phone because I still forget things I don't write down or get repeated.  The insurance guy already told me he doesn't have tie to repeat things to me and that I require too much time.  What the heck is that supposed to mean?

Anyway, I now continue to fight for my freedom and my life against a corporate giant who has paid off folks to say I am ready to go to work after knowing me for about an hour or less and essentially lying on me - over all the specialists I work with who say I am not only NOT able to return to work yet, but won't let me be released to vocational rehab until all my fractures have been healed and treated properly.  Yep, makes sense to me!!!

The insurance company actually causes almost more duress and emotional distress than the pain of the actual recovery itself.  A person shouldn't have to fight to medical care they are legally and medically entitled to.  An accounting of the company should have a checks and balances so those with disabilities aren't bullied like I am being bullied and plowed over.

The plot thickens......and the Insurance company is raping my attempts at recovery.  What to do now???  Exploring options, thinking of ways to communicate boldly and diplomatically.  Finding this resolve after waiting for about 7.5 months for a referral to surgery to be approved is disgusting and dishonorable at best.  Whatever happened to "Do No Harm"???

Anyways, just some updates and thoughts with the side of things we don't usually talk about publicly.