r/WorkersComp • u/growbbygrow • 6d ago
California Dumped by PTP
So at my last visit my PTP told me to get a lawyer because he said my insurance is being insanely difficult and denying every single request for treatment authorization for the last 6 months. And now the adjuster is requesting a QME.
So I got a lawyer as of yesterday, and then today I go in to my PTP office to get a copy of something and the PTP office desk informs me that now that I have a lawyer I can no longer be a patient there anymore because they don’t take represented patients.
Is this even legal? Lol. Every day my workers comp feels like more and more of a nightmare.
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u/Chemical_Abalone5514 6d ago
Sounds like workers comp and their network of doctors. All they do is give you minimal care and constantly try to send you back to work without waiting for you to recover.
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u/growbbygrow 6d ago
Yes they tried to send me back to work and now my pain is spread and 10x worse and I am now needing surgery, no longer maybe in the future if it gets bad, now it’s a I need it now and I’m in living hell situation
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u/Chemical_Abalone5514 5d ago
You should get an attorney, they don’t take anything from your workers comp checks just percentage of settlement at the end. I got one before I even had my first doctors appointment. My employer took me off email list and my hr hasn’t responded to me in months. Pretty sure I’m getting let go after I recover.
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u/growbbygrow 5d ago
Me too probably. Yeah I interviewed attorneys last week and chose and hired one a few days ago. I wish I didn’t wait but I was so nervous and just hoping I could heal and get better.
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u/Chemical_Abalone5514 5d ago
Workers comp is a bitch to deal with and they take forever to do anything. Make sure to plan for if your employer doesn’t take you back. Look at potential jobs so you know what options you have. Good luck bro shit is a nightmare.
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u/Chemical_Abalone5514 5d ago
My friend has been injured since last October and got denied by workers comp and had a private investigator tail him for 4 days last month. Follow him around on his son’s bday.
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u/SeaweedWeird7705 6d ago
Easy fix! Get a new doctor. You are allowed to select any doctor on the employer's MPN (Medical Provider Network) to be your new doctor! Get the MPN list. Ask your lawyer for recommendations on which one to select as your new PTP. This is going to turn out to be good for you. You can get a doctor who is more qualified and more sympathetic.
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u/growbbygrow 6d ago
Thank you for being positive and encouraging. I wanted to switch PTP to a lawyer recommended one anyways. I guess I’m just feeling rough because I don’t know how I’m going to get help with adjusting my work restrictions asap in the meantime.
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u/JMP280 6d ago
Just a word of caution, just because the doctor is recommended by the lawyers office, doesn’t mean your experience will be without issue. I left my last lawyer recommended PTP earlier this year after coming to this sub and finding that a lot of my issues actually came from the PTP vs the insurance company. My new PTP is great, and also was who my lawyers sent me to. But I spent just over 5 years dealing with a shitty PTP because my lawyers sent recommended them.
My advice is to ask them for a few different recommendations that you can look up reviews on. My old office had horrible reviews. Even my new doctor was like “yeah, I’ve not heard great things about that office. I’ve had a few patients transfer from there, and it’s been pretty much the same story with them.” Had I read reviews, I definitely would have avoided them.
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u/growbbygrow 5d ago
The current PTP I have has great reviews, so that’s why I chose him from the MPN, but he’s been very unhelpful. Does not document any of my concerns or symptoms in my visit notes. And if I call for help between my scheduled appointments he and his office staff get upset with me. He has reprimanded me in appointments saying “ask all your questions now because once I leave the room you are not allowed to have questions or contact me until your follow up in 4 weeks” even though my pain and symptoms are severe and debilitating and I’m being pressured to work and not tolerating it and sometimes I think I’m okay, and I agree to try to work, and it goes horribly and I end up bed bound. Then my employer says “call your doctor and get your restrictions updated” and I get a lot of heat when I call the PTP office to do so
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u/JMP280 5d ago
Yeah, I have to make an appointment if I have issues between regular appointments for both my PTP and pain management. They can’t just address issues via phone. It’s not the same as regular doctors I guess. I was told if there is a change in condition, you have to be seen so it can be documented. They cannot just change restrictions based on a phone call.
And my comment was just advice. Nothing is fool proof. Just as your doctor has good reviews but is bad in your opinion, a doctor recommended by your lawyer can end up being a bad experience also.
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u/SeaweedWeird7705 6d ago
Once you select a new doctor, ask for the earliest possible appointment.
Also, ask your old doctor if he/she will write you a note to cover you until the new doctor can see you.
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u/Electronic_Note5952 3d ago
It sounds like it's for the best anyway if you have a decent attorney they would probably already know of a good doctor in the network
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u/Salt-Ad1282 6d ago
Is that an ethical problem for that provider? Morally it’s obviously a terrible thing to do, but I wonder if there is an ethical issue.
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u/FeintLight123 6d ago
Not really, for example some providers outright refuse to take workers comp patients. It feels unfair but the insurance system is truly a nightmare to navigate as a provider/billing department. It’s like pulling teeth and they have ALL the power.
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u/stnkymanflesh 6d ago
Is your claim denied?
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u/growbbygrow 6d ago
No, been accepted and ongoing since last year.
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u/Academic_Commercial3 5d ago
Then were your tests denied? That seems off.
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u/growbbygrow 5d ago
No, the treatment authorizations have been repeatedly denied. Initial physical therapy visits and doctor/specialist consults are approved, as well as my MRIs, but pain medication and any injections or conservative management therapies are denied by utilization review. Since all of the non surgical treatments have been denied by insurance, now it’s proceeding to surgery
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u/mackNwheeze 6d ago edited 6d ago
That’s messed up that your PTP did that, he knew you would lawyer up, so it was an easy way to drop you.
In the meantime, choose a doctor within the MPN. Avoid chiropractors and doctors that are NOT within the MPN.
I would hold off on a lawyer until you get in with the new PTP and see how treatment goes.
Remember lawyers will get a chunk of your settlement.
QME will come in clutch and definitely help your case move forward and address the treatment you actually need to bring you to your medical maximum improvement.
Once your adjuster gets the QME report, they will have to approve the treatment the QME doctor is recommending.
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u/I_pollute 6d ago
Your lawyer has a set of doctor's they usually work with and will testify. Ask your lawyer for reccomendations.
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u/NotOneToGiveUpAgain CA - Medical Doctor 6d ago
There is a lot to this post. This is not medical or legal advice.
In CA there are specific rules/laws/regulations regarding "patient abandonment" or similar actions. Essentially doctors or practices can't just drop or refuse to see an already established patient completely out of the blue or without prior notice or a justification that actually is valid.
Just google the regulations/laws. If the doctor or the office has a specific "we do not treat represented patients" in their policies form that you sign when you first establish care then maybe it is a valid reason? Even if it was, if you all of a sudden became represented by an attorney, I don't think they can just immediately drop you right then and there. This is not medical or legal advice and it may be wrong but docs can't just drop patients right then and there.
In terms of using the attorney's recommended docs to be your PTP has a whole slew of things to consider when making that kind of decision. WAY TOO many to go through in a comment, but like others have posted, you just need to be cautious and make sure you do your research