Chronic Pain Support Group

Are you required to see only thier doctor? That seems kind of shady to me. I'd grab your policy and read it again. See what your rights are. Or better yet, if you can afford it, go talk to a disability attorney. I'm not an expert by any means but it sounds a bit "off" that they want you to go see only thier doctor. I understand that seeing a dr is required to better asses whether someone is disabled but to require you to go see only thier doctor doesn't seem fair to me. I'd check in to that before any damage is done by this other so called doctor. Good luck to you. I hope it works out.

~hugs

I handled my own WC case for a very long time and have worked on other files as well. Please give me a brief timeline of your case, i.e., from beginning of work injury to present. Review any paperwork you have pertaining to the Aetna contract for long term disability. You are being harrassed. From my experience and knowledge, you are always allowed the right to have your own doctor confirm your disability. They feed off of your emotions. I know from personal experience. And, anytime they are messing with money you need to live, it only adds to the anxiety. Also, what state do you reside in?
Colleen

I agree with kmiller. Check you policy to see if you need to go through their doc. Insurance companies in this country always make up reasons to deny people. It is really upsetting to hear you're supposedly a faker when you're legitimately in pain! These situations seem quite odd to those who've spent significant amounts of time in other countries. This wouldn't happen is Switzerland. This is why we need insurance reform. Off my soap box now, I believe that you are entitled to use your own doc to establish your claim. Just don't get caught doing anything that you claimed that you couldn't do. Insurance companies craftily follow folks around in their daily lives and film them doing yoga, lifting couches, etc. They might run out of tape filming me at the health club, but my couch lifting days are a distant memory. Good luck and sorry for the unnecessary stress. We believe you on DS!

Billy-

You might want to determine if you have to submit a request to see a doc of your choice. They have some such obscure rules in some states.

-Snake

Having worked in insurance, I can tell you that there is nothing shady about what they are doing. People tend to forget the world we live in. The insurance company has a duty to their shareholders to make sure that they are paying only legitimate claims. Thanks to the criminals, there is a whole field called SIU in the claims world. It stands for Special Investigative Unit. It is the fraud investigation section of an insurance company and I worked in this world for five years. While your claim may be legitimate, there are hundreds, even thousands of others that are not. There are people that live off of insurance claims and never had a job in their life. I've seen it many times.
So for your case, your options are go see their doctor, or as your policy says(I'm willing to bet everything I own on this), due to your failure to cooperate, your benefits will be cut off. Keep in mind that these doctors are not always "their" doctors. Most insurance companies use Independent Medical Examiners and their use of these doctors depend on more than just whether they find on their side or not. You may not believe me, but the way they judge whether to continue using these professionals depend on the doctor's experience(these docs usually have their own practice and their own patients, otherwise it's easy for an attorney to rip them apart), how concise the doc can explain their opinion, and if the doc can defend their position when challenged (like testifying in court). There are companies that provide these services, and that company is the only party that doctor has to answer to if problems arise. So these doctors are not dependent on the insurance companies to survive. This is the only way the insurance companies can actually defend any position any doctor takes on their behalf. Otherwise they would never win any cases or be able to deny any benefits. If you think about it in litigation, this makes sense, right?
You will have appeal rights or whatever they choose to call it. Your best bet is to be completely honest with this doctor. If you don't tell them about the difficulty you are having just functioning on a basic level, your frustrations with not being able to find medication that works, how you want to be able to function again. You can even ask him if he sees something that your doctors missed. If you hold back, they may not see the usual psychological signs that are present with someone with chronic pain. This may make them think you are actually not suffering from chronic pain.
You can always talk to an attorney but remember they cost money and it may not be necessary. You may want to see how far you get on your own and then if they seek to terminate your benefits, get an attorney involved. However, your best weapon is knowledge, Know your rights. Know the policy. Know what happens next if the doctor feels you are no longer disabled. Do you still have your job? If they deny you, do you go back to your same job? Did your managers see how your condition affected your work?
Have you filed for social security disability? How does that affect your payment ? Your long term disability does not affect social security payments (ssi yes, but social security no). If you are comfortable explaining your medical condition, you are your best advocate. If you are not, then it may be time to seek advice from an attorney.
Hope this helps.

As to the last reply, I am not even going to try and touch that one on an issue-by-issue basis.

I worked in insurance defense work (the insurance companies were our clients) for years. In fact, working for the senior partner, I spoke with the claims people on a daily basis. And yes, we found people who were fraudulent (like this woman who would drop hot tea in the restroom at McDonald's, slip on it, and collect a nice, tidy settlement. Settlement was the luck of the draw, i.e., it all depended on the insurance company. Yes, they did pay out bogus claims. In fact, I worked up trials where we settled (as is very frequent) on the first day of trial (a tactic used to stall). Insurance Companies/Doctors/Attorneys are in a category by themselves. And, many, many of these so-called doctors who give specialized opinions are bought and paid whores. That is the term we used in our office. And, I worked only for prestigious, well-known firms throughout my career in the SF Bay Area.

I just have some questions, what state are you in? Yes, there are some people who are fakes. Do you think that people who come to a support site for chronic pain are without merit?

Colleen

Colleen

I currently work in the health insurance industry and I can tell you from experience there are alot of "shady" things going on. I fight with them everyday and on occasion I have to call the washington state insurance commisioner to get there help fighting insurance companies. Your bigger plans like, Premera and Regence do follow the rules to a certain extent. But some of the other plans I have a really hard time with. United Health Care is one of the biggest problems we have. The docs I work for our considering pulling there contracts with them that how bad they are. I have Aetna as my own private insurance, as well as disability (god help me if I ever have to use it). The delay in payment tactics they use are amazing. I had a steroid injection done last year. They first denied my claim stating they needed an accident report filled out by me. That's fine very common. Faxed it back to them then 2 weeks later they denied my claims again for coordination of benefits. Called em up took care of it.. 2 weeks later they denied my claim yet again stating I needed ot complete a pre-existing form out. Keep in mind I've had this same insurance for 3 years. Once that was completed, I called to follow up (drs office was hounding me to pay) and they somehow lost the paperwork I sent them so I had to wait another 2 weeks to get confirmation. They finally processed the claim but it's just an example on the games they play with drs offices and patient's. So in my opinion it does seem a little "off" that they would ask you to go see one of thier doctors. It would't hurt to check into your rights under your states disability act. Just my opinion. :)

Colleen, there is no need to get so bitchy about it. I didn't attack you when you stated your position so I will ask that you offer me the same respect. If you are unable to do so then maybe it's best that you not offer your opinion at all.

We all give our opinion in support of the individual asking for help. If you disagree, it is your right to do so. However, you do not need to so rudely and childishly attack someone for not agreeing with your personal opinion. If you are in California then you know that things are out of control on both sides of the spectrum there. As for your ridiculous question, are you really so stupid to think that I would be on here asking for help and giving help in return if I thought these member's issues were without merit?!

I think it is pretty clear to everyone with chronic pain that we pay for what criminals and con artists do everyday. We get the short end of the stick because of it. I don't think anyone here has not had to endure some procedure or another that is due to the people who abuse the system. However, I do object when people generalize and demonize insurance companies and brand attorneys as saints. Personal injury attorneys in particular also abuse the system and abuse their clients. They advertise their services and make people believe that they won't get paid unless they get an attorney. Yet I hear stories after stories of people who got an offer, sought an attorney, and then got $2k over the offer made, but lost $20k to the attorney. How does the attorney justify their services to the client then? Social security attorneys have no power within the system. That's why you don't even have to be an attorney to represent someone. They make sure to get all the medical records to SSA and then collect $6,000 for that? You wonder why you see so many ads for these attorneys on tv? That's why. They barely have to work for theirs. But they depend on people believing their ads or else they would be out of a job. The only time they are absolutely necessary is when you exhaust your appeals and have to file a law suit in federal court.
So excuse me if I don't share your opinions, but once again, that is no need for your to attack me so viciously. If you cannot "promise to be nice" then shut the hell up and keep it to yourself.

I apologize to the other members that read this but I refuse to be treated like garbage publicly by another member.

Billy,
Read your policy very, very carefully. If you are not sure of what your rights are as a patient, call your insurance commissioner's office and talk to someone there. Read and reread the policy, I am hoping that this issue will get resolve for you sooner than later...

Good luck to you, sending good karma and positive thoughts your way.

Duly noted Exhausted Lady. I sent you a message privately telling you I was not trying to be negative toward you personally. And, I apologize if my comments came across in that manner to you or anyone else on this site. It is just that I like to give chronic pain patients the benefit of the doubt, having been there and done that myself. And, I am certainly not defending attorneys by any means.
Yes, we do have our own life experiences and debates over issues. But, calling someone names or telling them to shut the hell up is not appropriate. So -- let's just leave it there.