New Attorneys for my denied Bwc Epilepsy Surgery

[tigerchef1969]

Hi everyone! I have hired a new law firm to handle my case in regards to my appeal with the Bwc denied Epilepsy surgery! I have a Ime with a neuroseurgon on March 2nd, and Im sure he will write the report with agreeing with the Bwc that I don't need the surgery! it is so ironic to me though how the Bwc never questioned both 8 day veeg stays and all the other testing and I even looked to make sure it said on the c-9 it was for epilepsy surgery! I am getting so tired of waiting and waiting for these people to take care of what they should have already have done, meaning the Mco!!!!!!!!

[Tattoo2]

HI, Why would the neurosurgeon agree with WC that you don't need the surgery? Does he think you need or not? Maybe I am not understanding all that is involved in your earlier post. Do you have insurance of our own besides WC? If so, I'd use that for the surgery and let them duke it out with WC. I know this has to be so frustrating for you! I feel for you for sure. Please explain why the neurosurgeon would agree that you do not need the surgery? Tattoo

[howdydave]

It may all depend on how the question was asked...

e.g.; If they asked the doctor:
"Is the patient threatened with loss of life or limb if he does not have the surgery?"
and the doctor said "No;" then this can be interpreted as:

He doesn't need the surgery.

It all depends on how one defines "need."

Lawyers and insurance companies love to ask loaded questions!

[Tattoo2]

That sure could be, but if that is what they asked and he said no, then he responded wrong. We all know that people have lost their lives and others have lost the quality of the life they have to uncontrolled seizures, and as long as they occur and meds are needed and taken in the attempt to stop them, then life as they know it and even life itself is in jeopardy. The doc was not at all thorough if he answered in that way and negligent if he didn't get that point across. Someone needs to call WC and explain the nitty gritty details to them. After surgery, his productivity will have the opportunity to improve which may lessen the need for support by WC That should be a good trade off. In all honesty, if it is painted in this way to WC and they still refuse, it should be considered wreckless endangerment and if his life is threatened, then a greater charge. I'd send then a very nicely worded emailed letter if it were me. Can't hurt! Tattoo

[tigerchef1969]

Simply put for me I guess! is that the Neurosurgeon is an a independent voice in the matter! He will be asked to write a report after his exam to conclude to the Mco whether or I need the Epilepsy surgery or not? Simply put too it's all bureaucratic bull****, I think!!!!!!

[tigerchef1969]

I'm also very comfortable with the law firm I hired. but I'm still kind of frazzled and confused with everything that is happening in my life at this point! Mainly my Mom's cancer!

[tigerchef1969]

As far as the Neuro agreeing with Wc, he basically works for them? I do have Medicare and Medicaid, but highly dobt that will help? Like I said I want this nightmare to be over with it's been six years since my Tbi and I'm growing very tired!

[Porkette]

Hi Jeff,

I had to battle it out with B.C.B.S. yrs. ago when I had my surgery, they were refusing to do my surgery until I had my Epi, and neurosurgeon write them a lettter stating that they had tried all different types of AED's
as well as the ketogenic diet but nothing stopped my sz. completely. What I finally did is called the Epilepsy Foundation and they made my ins. co. give me a written document signed and dated that they would cover all my medical
expenses 100% . They were also reported to the state ins. agency for discrimination and endangering my life. You might want to give this a try or tell your lawyer to do this. Whatever you do set the legal contract up with your lawyer
so that your Drs. are repsonsible for all your legal fees and possible court costs by doing that you won't have to pay any money to your lawyer and the Drs. will realize that you mean true business. Here's wishing You well and May
God Bless You!

Sue