Should workmans comp pay for wls. - Page 2 - ThinnerTimes

lala46205 · 06-12-2008, 05:37 PM

You Also Have To Take In Mind How Much The Surgery Costs..i Dont Know About Anywhere Else But I Know Here Its Like A New House....

Godsblessedme · 06-12-2008, 06:42 PM

Quote:

Know About Anywhere Else But I Know Here Its Like A New House

wow a new house huh? must be a shack. haaa The surgery here in AZ was between
25,000 and 30,000 barring that you had no complications.

I am on like Medicaid program (state ahccssss but pay a premium to get the insurance well not since my husband left me) but anyway they paid for the surgery! Sure i waited 1 1/2 years and went thru 2 appeals and requirements but now i'm 6months out

are you on any kind of Ahcccss or Medicaid?

BuCwiLd · 06-12-2008, 06:55 PM

Quote:

Originally Posted by Godsblessedme

wow a new house huh? must be a shack. haaa The surgery here in AZ was between
25,000 and 30,000 barring that you had no complications.

I am on like Medicaid program (state ahccssss but pay a premium to get the insurance well not since my husband left me) but anyway they paid for the surgery! Sure i waited 1 1/2 years and went thru 2 appeals and requirements but now i'm 6months out

are you on any kind of Ahcccss or Medicaid?

no i am not.. binder and binder is going to help me get on social security and hopefully that will lead to medicaid or medicare.. state insurance turned me down saying that my w'c comp check were to much and would let me qualify for medical

lala46205 · 06-12-2008, 07:01 PM

i believe its more than that here..but hey im not livin luxurious yet lol

mistymee · 06-12-2008, 07:01 PM

Quote:

Originally Posted by Godsblessedme

wow a new house huh? must be a shack. haaa The surgery here in AZ was between
25,000 and 30,000 barring that you had no complications.

I am on like Medicaid program (state ahccssss but pay a premium to get the insurance well not since my husband left me) but anyway they paid for the surgery! Sure i waited 1 1/2 years and went thru 2 appeals and requirements but now i'm 6months out

are you on any kind of Ahcccss or Medicaid?

Dunno where lala is going in MA for hers.. I had surgery at Brigham & Woman's hospital in Boston.. It WAS very $$$ but I had lots of complications and my surgery was six hours not 2 as is 'usual'.. and I was in the hospital from Tuesday, early AM until Saturday afternoon. For a standard lap RNY with a two day stay, it would've been similar to your costs.

bridgetgirl · 06-12-2008, 07:06 PM

I can tell you in California when I was a work comp coordinator I helped 2 people get WLS through their work comp carrier. Again, this was in CA and benefits vary from state to state. If you require surgery to repair your back due to a work related injury, and a surgeon WILL NOT perform the surgery as a result of your weight your emplyer has the obligation to get you to that weight to deem you suitable for surgery. Rapid weightloss is the quickest way to get you ready for surgery to repair your back and settle your claim. Do not let anyone tell you differently. It does not matter how thin, how heavy, how old you are when you have the injury. Your employer has a responsibilty to get you back to your pre-injury capacity.

first of all you need a staement from your Primary work comp Dr stating that you need the surgery, that he cannot perform the surgery due to your weight and the he recommending you have gastric bypass to have rapid weightloss to get you healthy for surgery. Then the person that does the auth's submits that to the WC carrier. If they deny it (Im not sure the timeline to deny, accept or delay for more info) then you take it to your attorney to take in front of the Work Comp appeals board for a judge to rule on it. Again, you had this injury at work, your employer hired you "as is" and they are responsible for your healthcare, and getting you back to pre injury capacity.... or as much as possible to return you to that capacity.

I can help you with this, like I said I got this approved for 2 people in Cali. Also, I got weight watchers and Jenny Craig approved for people who had gained weight as a result of limited physical capacity as a result of their injury.

Youre gonna have to fight, so is your lawyer. Unless there is a law stating otherwise you are entitled. One of the people that I got approved I referred to Dr C, the other lived in Imperial Valley and used a Dr there.

Good luck pal, let me know how I can help!!!

If you had the same injury and were thin, and in the lab workout discovered you were diabetic or had hypertension they would have to get that under control. If you were 65 and had the same injury, but you had arthritis and degenerative chages to your spine due to your age, they would still have to do the surgery. When they settle the claim thats where it all comes out in the wash determing how much was because of the injury and how much was due to prexisting conditions.

bridgetgirl · 06-12-2008, 07:16 PM

P.S. I worked for a spine surgeon when I did this, I did it for 3 years (coordinating) dont let anyone tell you differently, you are entiltled to get back to your pre injury capacity.... thats what you have to remember. If you get the letter done soon you could have an idea on where you stand within 6-8 weeks. Also, if Work Appeals board denies it, you can appeal that to the state level. You need a lawyer who isnt lazy, in your case they may say that xx% of the injury was a result of your morbid obesity and xx% was due to the actual injury, thats where the rating comes in and the settlement is figured. Its a no brainer to have you proceed with rapid weightloss to settle your claim quickly.

Boy I could go on and on, let me know if I can help you anymore.

lala46205 · 06-12-2008, 07:23 PM

i was just curious how you get your ticker to show up i am having a hell of a time figuring it out..? thx

BuCwiLd · 06-12-2008, 07:24 PM

i have otten letters from 3 different doctors 2 of them being sugeons that i am a candadate for back surgery.. the list of things wrong with my back is looong.

.But i spoke with my lawyer and he said that they did not have to pay for the wls.. do you think i was lied to by the lawyer i feel like shopping my case around to see what i could find

bridgetgirl · 06-12-2008, 07:57 PM

Quote:

Originally Posted by BuCwiLd

i have otten letters from 3 different doctors 2 of them being sugeons that i am a candadate for back surgery.. the list of things wrong with my back is looong.

.But i spoke with my lawyer and he said that they did not have to pay for the wls.. do you think i was lied to by the lawyer i feel like shopping my case around to see what i could find

What you need is your surgeon to say that he is suggesting WLS to enduce rapid weightloss to have your surgery performed in a timely manner that will not be a detriment to your nurological systems. Trust me. You dont need to shop your case, you need to have your lawyer put that recommendation into your medical record. Saying Mr. So and So must lose 100 pounds before I do it does not cover it, it must be Dr's orders, okay? Trust ,me I know what I'm talking about. You asked for advice, I'm giving it to you. It must be dome precisely as I told you. make sure you make an appt with your surgeon ASAP. Then at the appt you can tell him you want to move forward with surgery asap and the only way to lose weight rapidly enough is through WLS, and you have investigated it. If you have WLS you will lose 100 pounds in less than 6 months. If you do it on your own...well need I say more?

Now you know better, until you have someone show you the WC code implying that your preexisiting MO condition isnt the employers problem, YOU FIGHT IT. K? Do not rely on what you hear, rely on what is written law.