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Re: [owcp] Re: group question

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  • FourDirect@aol.com
    In a message dated 9/14/2005 12:46:38 PM Eastern Standard Time, ... Lauralee, Thanks so much. I have the fee pay schedule and all that but where do I get the
    Message 1 of 13 , Sep 14, 2005
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      In a message dated 9/14/2005 12:46:38 PM Eastern Standard Time, RPCVLAJarvis@... writes:


      Reimbursements take about a month to 2 in order for you to get the
      check.  That is, if you fill out the paperwork "properly."  The main
      form that you need is an OWCP-915


      Lauralee,

      Thanks so much. I have the fee pay schedule and all that but where do I get the OWCP 915 form from? And you actually have gotten money when you've paid out of pocket?

      You don't even want to know how many tens of thousands of dollars I and my family have paid to keep me alive in those early years with marginal reimbursement. I am just trying to move ahead now.

      Nancy
    • lajarvis78
      ... do I get ... you ve paid out ... The OWCP 915 form is on the department of labor website: http://www.dol.gov/libraryforms/ Yes, you can get reimbursed...it
      Message 2 of 13 , Sep 15, 2005
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        > Thanks so much. I have the fee pay schedule and all that but where
        do I get
        > the OWCP 915 form from? And you actually have gotten money when
        you've paid out
        > of pocket?

        The OWCP 915 form is on the department of labor website:
        http://www.dol.gov/libraryforms/

        Yes, you can get reimbursed...it just takes tons of patients. I got
        about $3k from them in reimbursements. Be prepared for a fight and
        know that you deserve to get that money back. They will tell you
        that you are stupid for spending your own money...they will tell you
        that you filled out this form wrong...they will tell you that the
        doctor put the wrong code on invoice...just be prepared! Shed many
        tears and have spent hours equalling many days talking to people and
        filling out the paperwork, but it has paid off. Just don't give up
        and don't give in, that is what they are expecting, so then they
        don't have to pay you!

        As for a lawyer...I talked to many about my case. I wanted to do 2
        things 1) sue PC for talking over 5 months to diagnose and treat me
        and I am still not 100% over a year later (yes, I know a lot of you
        have been dealing with your issues for much longer and you have much
        worse medical problems...I am sorry for that, but I still have my
        frustrations over my issue and how it was handled by my PCMO). 2) I
        wanted to sue to get all my reimbursements back. 3) I wanted my
        PCMO fired. Sounds harsh, but she is not a nice woman and told me I
        deserved to be sick. She should not be treating Americans or anyone
        for that matter!

        I was told a lawyer who works in workman's comp claims is the best
        to contact. I contacted a few, but none would take my case. They
        felt going against the gov't was probably a loosing cause and I did
        not stand to make enough to make it worth their time (I still have
        not found a job and could not afford to pay a lawyer).

        However, I do have a friend and she found lawyers to take her case
        and have filed a large law suite against the PC. Sounds like some
        of you might have cases that a lawyer might take, I just couldn't
        find one for mine and contacted probably about 50. If any of you
        are in California (other states too, not sure how all that
        works)...maybe we could all ban together and make one huge law suit -
        I would help with that and be willing to share my story if it helps
        and gets word out there...just a thought...

        Best of luck everyone...
        --Lauralee
      • Felicia
        What I still don t understand is why my experience is so different from everyone else s. Sounds like lots of people were medically separated from the Peace
        Message 3 of 13 , Sep 15, 2005
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          What I still don't understand is why my experience is so
          different from everyone else's. Sounds like lots of
          people were medically separated from the Peace Corps.
          When that happened to me, they filled out the initial
          worker's comp forms right there. Was this just because I
          was nuttier than a fruitcake and hysterical? Once my case
          got accepted, I was assigned a nurse who has dealt with
          everything for me. Am I the only one on the list
          suffering from Peace Corps related psychiatric problems?
          There has to be a pattern here, and I'd like to know what
          it is. -- Felicia

          >> Thanks so much. I have the fee pay schedule and all that
          >> but where
          > do I get
          >> the OWCP 915 form from? And you actually have gotten
          >> money when
          > you've paid out
          >> of pocket?
          >
          > The OWCP 915 form is on the department of labor website:
          > http://www.dol.gov/libraryforms/
          >
          > Yes, you can get reimbursed...it just takes tons of
          > patients. I got
          > about $3k from them in reimbursements. Be prepared for a
          > fight and
          > know that you deserve to get that money back. They will
          > tell you
          > that you are stupid for spending your own money...they
          > will tell you
          > that you filled out this form wrong...they will tell you
          > that the
          > doctor put the wrong code on invoice...just be prepared!
          > Shed many
          > tears and have spent hours equalling many days talking to
          > people and
          > filling out the paperwork, but it has paid off. Just
          > don't give up
          > and don't give in, that is what they are expecting, so
          > then they
          > don't have to pay you!
          >
          > As for a lawyer...I talked to many about my case. I
          > wanted to do 2
          > things 1) sue PC for talking over 5 months to diagnose and
          > treat me
          > and I am still not 100% over a year later (yes, I know a
          > lot of you
          > have been dealing with your issues for much longer and you
          > have much
          > worse medical problems...I am sorry for that, but I still
          > have my
          > frustrations over my issue and how it was handled by my
          > PCMO). 2) I
          > wanted to sue to get all my reimbursements back. 3) I
          > wanted my
          > PCMO fired. Sounds harsh, but she is not a nice woman and
          > told me I
          > deserved to be sick. She should not be treating Americans
          > or anyone
          > for that matter!
          >
          > I was told a lawyer who works in workman's comp claims is
          > the best
          > to contact. I contacted a few, but none would take my
          > case. They
          > felt going against the gov't was probably a loosing cause
          > and I did
          > not stand to make enough to make it worth their time (I
          > still have
          > not found a job and could not afford to pay a lawyer).
          >
          > However, I do have a friend and she found lawyers to take
          > her case
          > and have filed a large law suite against the PC. Sounds
          > like some
          > of you might have cases that a lawyer might take, I just
          > couldn't
          > find one for mine and contacted probably about 50. If any
          > of you
          > are in California (other states too, not sure how all that
          > works)...maybe we could all ban together and make one huge
          > law suit -
          > I would help with that and be willing to share my story
          > if it helps
          > and gets word out there...just a thought...
          >
          > Best of luck everyone...
          > --Lauralee
          >
          >
          >
          >
          > ------------------------ Yahoo! Groups Sponsor
          >
          >
          > Yahoo! Groups Links
          >
          >
          >
          >
          >
          >
          >
        • Heidi Fassnacht
          Nancy, I do have experience with retroactive authorization. I started the process in 2003, and finally got paid (not everything, of course, but enough that the
          Message 4 of 13 , Sep 15, 2005
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            Nancy,

            I do have experience with retroactive authorization.
            I started the process in 2003, and finally got paid
            (not everything, of course, but enough that the rest
            isn't worth the hassle to get) in 2005.

            My application was the same as would be one for
            regular authorization, but for services that happened
            in the past and I titled my application as "request
            for retroactive authorization.' I have a list at home
            of what they told me I needed on the authorization
            request, if you are interested but it is from 2003 so
            who knows if it is still valid.

            After faxing in 20 pages of request plus supporting
            documentation twice (they wouldn't accept anything but
            fax, which costs a fortune) they finally received my
            request. Months later and after many many calls, they
            said they had approved authorization first for part of
            the time, then the rest. One provider then submitted
            paperwork, and got paid fairly quickly (and paid me
            back since I'd already paid out of pocket). The other
            provider took a lot longer to have success. I made
            the mistake of putting all my providers on one
            authorization request. I guess even though everyone
            was listed under the provider section of the request,
            ACS just considered the first office to submit a
            payment request to be the one the authorization
            covered. ACS didn't tell me this was the problem for
            over a year (they had a whole list of other reasons
            for why our claims were being denied). Finally, ACS
            told me I needed to write a letter asking for the
            provider covered by the authorization to be switched,
            which I did.

            Of course I never got a letter saying anything had
            happened, so I called to check in with ACS, and they
            said they had indeed switched providers. So we
            submitted again; this time ACS denied they claim on
            grounds of untimely filing! Can you believe it?! I've
            found in a couple circumstances that denial of a claim
            for untimely filing to be ACS's last attempt when
            they've run out of other possible reasons. I called
            ACS and explained the situation, and shortly after my
            provider got paid. As with the first, since I'd
            already paid the provider out of pocket, the provider
            sent me a reimbursement check. I have not tried to be
            paid back directly.

            A side note - When I finally got someone to tell me
            that I should have had different authorization for my
            different providers the ACS person told me this
            misunderstanding on my part shows why the providers
            should really be submitting all this paperwork since
            they understand how it all should be done. Such a
            joke! The providers with whom I have been working
            have been extremely patient with this process and in
            working with me, but have no more clue than we do
            about how this process works. I was even told by one
            provider (from a different reimbursement saga) that I
            should come in and talk to their staff about how the
            system works since I knew so much more about it than
            they did. This is why I thought setting up a listserv
            would be so helpful. We seem to be our own best
            resource.

            Hope that helps some.

            Heidi


            "In the end, our society will be defined not only by what we create, but also by what we refuse to destroy." John Sawhill



            __________________________________
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          • FourDirect@aol.com
            Heidi, Thanks so much for sharing your saga. My deal is that my providers won t take reimbursement even if it is sent to them. I have some that I have
            Message 5 of 13 , Sep 15, 2005
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              Heidi,

              Thanks so much for sharing your saga. My deal is that my providers won't take reimbursement even if it is sent to them. I have some that I have authorization for. My key question is if I still need a HCFA 1500 form and do I submit that bill completely filled out with proof of my own payment?

              Nancy
              PS How are you?
            • FourDirect@aol.com
              Felicia, I m so pleased that you had a good experience. I think you are a rare and fortunate person. I was NOT medically separated and that was part of the
              Message 6 of 13 , Sep 15, 2005
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                Felicia,

                I'm so pleased that you had a good experience. I think you are a rare and fortunate person. I was NOT medically separated and that was part of the problem in that my illness manifested itself after I returned home - bovine tuberculosis in the lymph nodes that then spread and wasn't diagnosed for a couple of years, along with a very rare form of meningitis and encehaplitis. So, proving the correlation was a challenge. But thereafter I've had to fight for every authorization, every bill and everything else.

                Nancy
              • FourDirect@aol.com
                Lauralee, Okay. I know the scenario very well. It is like a Who s on First routine only it isn t funny after all these years but that is exactly the way the
                Message 7 of 13 , Sep 15, 2005
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                  Lauralee,

                  Okay. I know the scenario very well. It is like a "Who's on First" routine only it isn't funny after all these years but that is exactly the way the conversations with all of those people go.

                  So, I will download the form and hope for the best.

                  I had the same experience with workers' comp lawyers way back when. No one wanted to touch the feds with a 10 foot pole. And we honestly do know more than anyone else can. It's just power we need.

                  Best,
                  Nancy
                • FourDirect@aol.com
                  In a message dated 9/15/2005 1:06:05 PM Eastern Standard Time, ... Lauralee, I m in NY but I d join any lawsuit group in a New York minute! Nancy
                  Message 8 of 13 , Sep 15, 2005
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                    In a message dated 9/15/2005 1:06:05 PM Eastern Standard Time, RPCVLAJarvis@... writes:


                    If any of you
                    are in California (other states too, not sure how all that
                    works)...maybe we could all ban together and make one huge law suit -
                    I would help with that and be willing to share my story if it helps
                    and gets word out there...just a thought...

                    Best of luck everyone...
                    --Lauralee


                    Lauralee,

                    I'm in NY but I'd join any lawsuit group in a New York minute!
                    Nancy
                  • Felicia
                    Oh, yes, I m very aware how lucky I have been. I almost wonder if it is because people who have had problems with Lariam occasionally kill themselves and if I
                    Message 9 of 13 , Sep 16, 2005
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                      Oh, yes, I'm very aware how lucky I have been. I almost
                      wonder if it is because people who have had problems with
                      Lariam occasionally kill themselves and if I was sent home
                      from the Peace Corps with mental problems and then
                      promptly killed myself there would probably have been an
                      uproar. Don't know if that had anything to do with it or
                      not.

                      Anyway, sounds like you have had a much harder time than I
                      have. So sorry. -- Felicia

                      > I'm so pleased that you had a good experience. I think you
                      > are a rare and
                      > fortunate person. I was NOT medically separated and that
                      > was part of the problem
                      > in that my illness manifested itself after I returned home
                      > - bovine
                      > tuberculosis in the lymph nodes that then spread and
                      > wasn't diagnosed for a couple of
                      > years, along with a very rare form of meningitis and
                      > encehaplitis. So, proving
                      > the correlation was a challenge. But thereafter I've had
                      > to fight for every
                      > authorization, every bill and everything else.
                      >
                      > Nancy
                      >
                    • Kaericsson@cs.com
                      16 September 2005 Hi All: Finally I, too am writing. It has been interesting following all of your correspondense. I was also separated from the Peace Corps in
                      Message 10 of 13 , Sep 16, 2005
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                        16 September 2005

                        Hi All:

                        Finally I, too am writing. It has been interesting following all of your
                        correspondense.

                        I was also separated from the Peace Corps in 1988 due to psychiatric
                        problems. Actually this did not develop from culture shock or job related difficulties
                        while on site, but due to boyfriend problems. Coulda happened anywhere -- it
                        happened while I was in training in South America. I developed a sleeping
                        disorder. Of course, day to day stresses probably did aggravate the situation.
                        Peace Corps took responsibility for all aspects of your life -- kind of them! I
                        asked for counselling through Peace Corps right away, but the infrastructure
                        was not there. They provided it for me a year and a half later, but by then it
                        was too late. I was losing so much sleep I was hallucinating. I was sent home
                        after a year and nine months of service.

                        I felt the Peace Corps did their job once I was back stateside, and my
                        expenses for psychiatric care are still handled by US Dept. of Labor OWCP. However,
                        even then OWCP was a dinosaur. I had to handle all the paper work for
                        reimbursement for medications. Finally OWCP got my pharmacy in the system, and I don't
                        have to pay much attention to that any more. However, like with the rest of
                        you, it is getting more difficult in other ways.

                        In December 2004 the psychiatrist handling my medications retired. His
                        replacement was not considered a provider under OWCP. They would not pay him for my
                        office visits. Now, I have had dozens of doctors treating my disorder since
                        1988, because I have moved a lot, and so have my doctors. This was the first
                        time OWCP had not accepted one as a provider, as far as I know. Finally he has
                        been paid for my three office visits, 10 months after I first saw him. He has
                        drummed it in to me that fewer doctors are taking OWCP patients for this very
                        reason -- it appears to be the most cumbersome health insurance agency in the US.

                        Getting reimbursement for lab work has also become screwy this past year.
                        OWCP would not accept the diagnosis codes submitted by my current doctor for my
                        lab work -- they would not accept the specific code for my disorder, only a
                        "nonspecific diagnosis" code originally submitted when I originally returned from
                        the Peace Corps, before my diagnosis was solidified. With the help of Rep.
                        James Oberstar those bills have now been paid, but I think still using that
                        "nonspecific" code. I know OWCP has codes available for my disorder -- and my
                        psychiatrist thinks it would be better to use them. Some of my doctors used them
                        successfully with OWCP earlier. (Go figure.)

                        Tomorrow Oberstar will be in my town at a fundraiser dinner and I believe
                        will be taking a moment to speak with me in person. I dropped off copies of some
                        of your letters at his area office yesterday so he'll have a chance to look
                        them over. We need to develop a unified approach to encourage US Dept. of Labor
                        OWCP to deal with its current and former employees in an equitable manner. I
                        know that their personnel are overstretched and subject to rapid burnout -- but
                        whose problem is that?!

                        This group serve is a good start. What's the next step?
                        I am open to suggestions.

                        Sincerely,

                        Kriste Ericsson
                        Paraguay 87-88
                        Minnesota
                      • FourDirect@aol.com
                        I ve heard of so many people having a terrible time with Larium. I am glad that you are still with all of us! Nancy
                        Message 11 of 13 , Sep 16, 2005
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                          I've heard of so many people having a terrible time with Larium. I am glad that you are still with all of us!

                          Nancy
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