The WC Insurance company sent me to see two doctors and the second one recommended I seek treatment from the surgeon who had successfully repaired my right shoulder a decade earlier. After weeks of WC Insurance company induced delays, I met with the surgeon and we scheduled surgery. However three weeks before the scheduled surgery, the insurance company refused to pay for the surgery. That was September.
Since then I have hired a lawyer and started the very slow process of forcing the insurance company to do something other than collect premiums and push papers. Dealing with the bureaucracy associated with Workers Compensation has been an agonizingly slow process, but things have finally reached a point where I'm hopeful there will soon be a change. In mid November I saw a QME doctor1 who has issued a report stating that I definitely need surgery.2
This little essay is not seeking your pity or concern. I'm actually doing fairly well even tho I cannot move my left shoulder, and I'm in the hands of a top notch surgeon. Mostly I wrote this to inform those of you who are wondering why I canceled the weekend retreat in Los Angles. And I also wrote this as a cautionary tale: you may think you have health coverage - but you may have a rude awakening if you try to use your coverage.
27 November, 2005
1. Qualified Medical Examination doctor - like a medical arbitrator.
2. Update 7 Dec '05: The insurance company is now trying to weasel out of paying by suggesting my frozen shoulder is a result of teaching meditation(!!!). Click here to see the FAX they sent to my surgeon once again denying surgery.
Update 24 Jan '06: I had successful shoulder surgery today. Unfortunately, I had to pay out-of-pocket; I'm suing the insurance company.
Update 17 Apr '08: The insurance company finally agreed to pay all my costs including the lawyer's fee and interest - the check arrived today. What a hassle!
Altho "Obamacare" was a very nice step forward in American health care, it does nothing to solve problems like what is described above - the private insurance companies are still calling the shots. The only solution is a Single Payer Health Insurance system - Medicare for All. However there is a lot of resistance to Single Payer - fueled of course by the private insurance companies. These Myths and Lies will need to be rooted out before America has a decent healthcare system.
Single Payer Health Insurance Myths and Lies
Picture of how bad health care is in the USA
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