I'm going to try to keep this as short and to the point.as I can I have 3 herniated lumbar discs, My insurance carrier recommended and required me to have Epidural Steroid Injections. I declined, they forced me to or else they would not pay for any further treatments.
The first ESI done by anesthesiologist in hospital had caused a dural puncture, punctured my spinal cord, this resulted in nerve damage and furthering my disability.
My Insurance company insisted and required I have 2 more ESIs by another doctor,neurologist, pain management in office, I did, Neurologist said I could NOT have any more ESIs
My insurance company under recommendation of their doctors required me to have a 4th ESI. I flat Out Refused, they said again if I didn't have it done they'd not pay for further treatment. I had it done by same neurologist, even though I reminded him he said I could not have any more he told me he's doing whatever the insurance company tells him.
I finally have surgery,should have been minimal invasive, ended up being open back.
The end result is I became worse after each " treatment ", each treatment caused more problems and now I have arachnoiditis.
Is insurance company at fault, the anesthesiologist that started this, the neurologist that proceeded against his own statements, the back surgeon that performed open back surgery or am I because I gave consent even though it was NOT Informed Consent,
None of the doctors told me each of their procedures have the risk of arachnoiditis even though ALL of them do.
Thank You everyone that answered, I guess I should have mentioned that this is workers comp insurance. That means that if I don't comply they not only don't pay for my medical treatments they ALSO stop my lost wages insurance, No income, they then notify my employer and give them a reason to terminate my employment. No Income, I have a family to support as do most of you so I chose to put my faith in that the doctors know best and I thought worst case the treatments don't work, That ended up not being the case the treatments made my condition deteriorate.and caused additional conditions. I'm not looking to blame anyone, Only I am now having and going to have for the rest of my life pain and symptoms of paralysis and need to know who is paying for my medical care
debijs, It is nice to hear from someone on the inside that has experienced the same from another angle
Casey Y
You have nothing against the insurance company, they gave you the option of discontinuing your treatment and you chose to proceed. I know that probably seems heartless, but that's just the way it is.
As for the doctors, you might have something there. They chose to perform treatments, possibly against their better judgment, because they knew that they were going to be compensated. That is a wicked conflict of interest and you might have a case on that front.
As for the informed consent, that is usually a difficult one to prove. You would be surprised at how often people do not hear everything when it involves their health. I have seen people after a meeting thinking the meeting went two different ways; I am referring to a husband and wife on the same side.
mbrcatz
No, the insurance company doesn't actually RECOMMEND or PERFORM any medical procedures. They only tell you what they'll pay for.
You're welcome to stop treatment at any time.
I'm sure the anesthesiologist let you know that your complication, is very common with that procedure.
You sure can try to sue them, if you can get a lawyer, for medical malpractice. But the fact of the matter is, with your type of back problem, the more you treat, the more you mess it up.
Only 30% of the time, do people with back issues see improvements after surgery. I'd bet dollars to donuts, whether or not you think consent was informed or not, they'll be able to produce documents with your signature at the bottom of them, that have all the information laid out in the documents.
debijs
~~I ran into this type of situation many times working in authorizations. You have had serious injuries due to the insurance company demanding these procedures be done, against the doctor's advice. I have dealt with many case managers who insisted on doing things the "cheaper" way than what was medically required, so do not let anyone tell you they do not interfere with care, because I fought them for our patients care-I know for a fact they do!
Consult with a few different personal injury attorneys (try and get referrals on good ones in your area). You will have a very long battle (insurance companies are rich and have the best attorney's), but maybe when you make your point you will have helped other people suffering as you are going to have to now. Maybe a jury will award you a fair compensation for the long life of pain you will now endure.
I also think the physicians involved are at fault as well. They should have fought with the insurance company with reports as to why these procedures were not in your best interest. They can fight and have an insurance decision over-turned. Best of luck to you.~`
Orignal From: Medical Negligence At Fault?
Post a Comment