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Re: group question

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  • 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 1 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 2 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 3 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



          __________________________________
          Yahoo! Mail - PC Magazine Editors' Choice 2005
          http://mail.yahoo.com
        • 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 4 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 5 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 6 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 7 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 8 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 9 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 10 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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