Q: I have many years of experience with Doctors and undisclosed diagnostics that eventually lead to serious problems
requiring major surgeries. My prexisting condition of MS was very managable until a surgeon claimed to find an L5 fracture. I have since had 4 lumbar surgeries. The first 3 failed, Doctors blamed MS. My Injury was found out of network then corrected on 4/2/19 followed by 2 weeks of acute care. I returned to network to complete 4 more weeks of inpatient. With covid in 2020 my final 6 wks of P.T was @ home. Still in intense pain, I was never able to get out of the wheelchair assigned after 4th surgery. While continuing to treat pain today, I am pushed out of any new office because of my complications- I am fused from S1-T10. I have worked with my PC all year to address severe pain in my right hip. I have ordered and viewed my current diagnostics which list my new conformities that keep me in a chair. If I tell new Drs I need help because of a subsequent injury (undisclosed since '15) to root nerves, I am referred out. Who is responsible? My insurance, for authorizing the procedures?
A:
A Washington attorney could advise best, but your question remains open for a week. It could be difficult for a non-medical professional to make a call here. I'm very sorry for the pain you are experiencing, but given the long history of treatment and multiple surgeries, it could be difficult to pinpoint what the cause of the problems could be. You could reach out to other attorneys for their opinions, but in my experience, I have not seen insurance carriers be liable for authorizing procedures in good faith - sometimes the opposite takes place, where they are challenged in an arbitration or court proceeding as to medical necessity when they deny procedures. One option is to reach out to attorneys to discuss your file in further detail. Good luck
Tim Akpinar
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