I worked long and hard to win the battle in my workers’ compensation case. After years of battling I was awarded lifetime medical. Finally, I thought I would be able to work toward healing without stress of the huge financial burden I had been under for so long. I would submit my self-procured medical expenses and I would be reimbursed.
I had no idea how long things take in the workers’ compensation world. I would submit my bills in a timely fashion once a month only to wait months and sometimes nearly a year to get reimbursed. I had hope because I was awarded the medical and would just have to wait and fight to get reimbursed on time. Things were starting to go smoothly and wham another obstacle was placed in front of me. My case had been handed over to a different insurance carrier who decided that they shouldn’t have to pay for all the things the previous insurance carrier covered. We fought again and again.
It wasn’t too long after that when yet another insurance carrier now had my claim and was refusing just about everything at that point. We fought and fought utilization review with letters and fought in court. Finally we agreed for me to see an AME (authorized medical examiner). This doctor would review my records and meet with me. He would become the final say in my treatment and if the insurance carrier denied anything, it would be sent to him for approval. My treatment expenses would no longer have to go to utilization review and it would save time in getting me reimbursed.
That was the final blow to me regarding my lifetime medical care. This doctor denied my seeing my environmental doctors and he denied my seeing my ENT who has been in charge of a lot of my care since I first became ill. I was then told that I needed to see a traditional doctor who was board certified in allergy and immunology, possibly an infectious disease doctor, a different ENT, and as you might suspect a psychiatrist.
What this all boils down to is that if I want to continue my LDA (low dose antigen) therapy, continue seeing my environmental doctors, continue seeing my ENT, doing my B12 injections and Vitamin IV’s and quit speaking to my therapist in lieu of a psychiatrist or clinical psychologist, I must foot these bills myself without expectation of any reimbursement.
So lifetime medical now only means lifetime medical if I give up what is making me well in exchange for what the AME wants me to do. Tough decisions are going to have to be made and I am still deciding what I am going to do.