Anyone have to appeal thier insurance to continue physical therapy?

Discussion in 'Fibromyalgia Main Forum' started by painfreesoon, Jul 28, 2010.

  1. painfreesoon

    painfreesoon New Member

    I HAVE to have P.T. for quality of life. Otherwise I end up almost completely bedridden.
    I have been going for years.
    My Rhumey has done the peer to peer review, and all has gone well, except now.

    I got the decline notice stating MY RHUMEY said it was NOt helping and that I refuse to take FM meds!!! Thats so not true, and he knows it. He;s always been helpful, and said he'd work with this for me. So I don't know if he was misunderstood, or if he's frustrated with the system, or what.

    I have an appt. at the end of Aug., but we have a short time to get our last 2 appeals in.

    I'm really hoping they misunderstood him, otherwise I have no idea why he would say that,we've talked about those very things.
    He even wrote a letter 2 yrs. before stating the fact that P.T. does help, and I tried FM meds, like Lyrica, and couldn't take it due to side effects.

    The only other thing I can think of is my ins. out and out lied.

    I guess, I'm mainly hurt, confused, needing to vent, and wondering if I'm the only one with this experience.

    Thanks, it's ben about 1 yr., since I've been on this board, but I have no one to talk to, and this is really bothering me.

    take care
  2. Tizz

    Tizz New Member

    ...are not exactly unheard of!!

    However, even my favorite (family) doc will occasionally do/decide something that she hadn't discussed with me at all. Usually it's because she got a report or labs from some other medical professional that changed her mind.

    You do need to talk to your rheumy as soon as you possibly can. But I know these docs are usually very busy... Have you talked to his office staff, to ask them if it's possible to put your name in if your doc has a cancellation before your scheduled visit? If you get lucky, you might be able to see him sooner.


  3. painfreesoon

    painfreesoon New Member

    My doctor has the appeal papers, he just didn't read them!
    He did not say what they did, so now we have to try to straighten this out before my last 2 appeals do.

    it will be the insurances fault, if that happens though.

    My doctor knows how severe my condition is, and has been on my side. I went through MANY doctors before I found him.