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Re: [owcp] Re: group question

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  • 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 1 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
      >
      >
      >
      >
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    • 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 2 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
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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 3 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 4 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 5 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 6 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 7 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 8 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 9 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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