Should workmans comp pay for wls. - Page 3 - ThinnerTimes

Godsblessedme · 06-12-2008, 08:10 PM

Quote:

If you have WLS you will lose 100 pounds in less than 6 months

be careful what you say that is only for a highly above average person. Not everyone looses 100 pounds in 6 months.

State to state workers comp differs so much. I was an administrator for several medial practices and WLS was not covered under workers comp. the back surgery would have been covered and even if your doc HERE IN AZ anyway, wrote specific orders to rapidly loose the weight, prior to the back surgery, it is not WC's responsibility to cover that rapid loss. Your attorney knows YOUR states statutes and laws and limitations, and therefore i would go off of his / her advice. But if you were on the medicaid / medicare/ahccsss, they would cover that WLS and then WC responsible for the back surgery. You could always contact another WC lawyer and just get a 2nd opinion as to what your PA law states regarding that

BuCwiLd · 06-12-2008, 08:20 PM

here is part of what one surgeon wrote in the letter..

"at this time marvin is not deemed to be a surgical candidate due to his morbid orbesity.. i advised that he pursue bariatric surgery to lose enough weight (100lbs) if he wished to be considered for surgical options which may include fusion or disc arthroplasty."

bridgetgirl · 06-12-2008, 08:43 PM

Quote:

Originally Posted by Godsblessedme

be careful what you say that is only for a highly above average person. Not everyone looses 100 pounds in 6 months.

State to state workers comp differs so much. I was an administrator for several medial practices and WLS was not covered under workers comp. the back surgery would have been covered and even if your doc HERE IN AZ anyway, wrote specific orders to rapidly loose the weight, prior to the back surgery, it is not WC's responsibility to cover that rapid loss. Your attorney knows YOUR states statutes and laws and limitations, and therefore i would go off of his / her advice. But if you were on the medicaid / medicare/ahccsss, they would cover that WLS and then WC responsible for the back surgery. You could always contact another WC lawyer and just get a 2nd opinion as to what your PA law states regarding that

This was my job to fight to get medical benefits and treatment to the injured worker, it is up to the law of the state, no one else. Not a practice, not a lawyer, not a wc carrier. It is contignent on the law, and law only.

Your lawyer may not have lied to you, he may be unsure is all. There are 1000's of pages of writtten law it can be overwhelming to tackle a new issue like this. Like I said it will take alot of time in and out of court to get it approved in fact it is lawful. It is my expereince that your employer has to do whatever they can to return you to your pre injury capacity. retrining you through voc rehab will not solve the problem, no matter what your new occupation you will be limited to prolong standing, sitting, stooping, reachinf, bending, climbing, etc. It has nothing to do with the medical practice nor the wc carrier, it boils down to what is lawful when it comes to employer responsibiltity. Like I said before, I got it approved for 2 people in the past.

Men have the fortune of losing 100 pounds in the first 6 months. usually they lose more. There is one gent here who lost 200 pounds in the first 6 months. That is the great fortune of being man, yes it does take men 6 months to lose 100 pounds, especially if they are near the 300 pound mark.

Relying on medicaid to approve this is not necessarily the answer either. Again, depending on your state your MO could be a pre existing condition and they dont have to approve it.

The long and short of it is turning to state law, and if you rec'v medicaid electing a HMO that does not have pre exisiting exclusion on treatment.

BucWld your letter is perfect, contact the wc coordinator at that practice and asked if she has submitted auth for a consult with a bariatric surgeon yet so you can expedite your spine surgery. If she hasnt give her the name of the Dr you found and see if she will do it for you. If she wont, have your lawyer do it. Let me know what happens.
Dont feel ike your lawyer has lied to you, he may not know better. There are 1000's of pages of case law, and that can be overwhelming. Stick it out, fight the good fight. That time is going to pass anyways while you wait for approval from WC or Medicaid anyway. Good luck.

Josephine · 06-13-2008, 03:36 AM

Marvin,

Just so you know, if you do take the next couple years out and spend it fighting for your disability, you may get it but then you have to be drawing disability for 24 months before your medical kicks in.

You're looking at 5 years before you'd be able to have GBS and then the back surgery. That's a long fight. I'd listen to Bridget and fight for WC to pay for WLS.

BuCwiLd · 06-13-2008, 07:20 PM

well i made all the nessasary calls today and was told by two different lawyers that yes i could make them pay for the surgery but it would cost 5-6000 dollars in court and lawyer fees in addition to 20 percent of my workmans comp check every week. (i cant afford that).Good news is my lawyer told me that i do qualify for social security disability benefits and to go ahead and apply and when i get the denial letter (everyone gets denied 1st time around) to call her and she will get me in.She even said that they may say i have been qualified since last year and medicaid kicks in 2 yrs from the date you are said to have become disabled. hopefully they will push it back to when the doc pulled me from work march of 07.