LTD company sending me to FCE even though I am Bedridden!!!!
AnonymousMarch 9, 2011 at 1:25 pm
Is that even allowed???? I had my Neurosurgeon fill out an FCE form when I was with him last week. I also had another doctor deem me on the
Karnofsky Scale: Not able to work or do anything, bedridden
This is because I am sleeping 3-4 days at a time. My LTD company is making it sound like if I don’t go to this functional capacity exam this Friday, they are going to pull the plug on my benefits! I’m like ” don’t you get what bedridden means”!!! No, instead they are sending me to do an FCE in Boca Raton, 73 miles away from my house!!! He says they will provide the transportation, but I just can’t understand why they can’t find a phy therapist here in Miami!!! Miami is hude!!! I get my phy therapy here in Miami at home, in bed!!! That’s because he has to come at 4, wake me up to do the phy therapy, and then I go back to bed! I don’t know what to do… I don’t think I am going to make it:-(
AnonymousMarch 9, 2011 at 3:24 pm
Sorry to hear things aren’t well.
I had a thought…is it possible to get a letter from your doctor saying that you are not well enough to travel that far?
What kind of transportation are they going to provide?
Is it private so you can sleep? Will you be able to lie down?
My thoughts are with you, good luck
Let us know what happens
AnonymousMarch 9, 2011 at 5:16 pm
I used the title ‘Insurance Company Denials’ because an LTD Company is just another Insurance Company. And, while not an outright denial, the steps to follow are the same.
Therefore, what that means is follow all the advice given to those whose insurance company has denied their benefits.
1. Know what your LTD policy says.
2. Contact the Company- yes, probably that person whose name is on the letter telling you must go to (fill in the blank) and you must use their provider. If not them, find out who your case agent is. Talk to them. Eliminate the inhumanity of letter writing. Of course, write down who, what, where, when and all that.
No doubt, you’ll find they have the right to send you to their own provider.
3. Yes, you can bet they will send you to somebody who looks at life through the insurance company’s eyes, not yours.
Make the call. Persevere.
AnonymousMarch 9, 2011 at 10:05 pm
Ask them what kind of transportation they are sending. Tell them the transportation you need is an ambulance so you can sleep on the way up and that also while trying to do the FCE you will most likely need to sleep some more and you would need a bed to sleep in or the bed from the ambulance.
AnonymousMarch 10, 2011 at 1:46 pm
I would think a letter from your dr stating you are bedridden & unable to make the journey would exempt you from having to make the trip.
You should probably have a case worker at the LTD. I would call & ask to speak to him/her…or at the very least someone in charge.
AnonymousMarch 10, 2011 at 9:02 pm
Check the language on your LTD policy. Many policies state that an insured must undergo “independent” medical examinations as often as is reasonably necessary. Of course, the examinations are anything but independent, and reasonably necessary is in the eye of the beholder. Be very careful in dealing with LTD on this issue. Your failure to attend the FCE without good reason will certainly be viewed by LTD as a refusal to cooperate on your behalf — and can be used as a basis to deny coverage.
Enlist your physician’s assistance. See if he is willing to write a letter on your behalf requesting that LTD use a local physician. Advise LTD of your limitations. Contact the State of Florida’s insurance commissioner’s office and enlist that office’s assistance. It’s free, and the insurance commissioner wields a great deal of clout with insurers. Also, I understand that Florida has a very tough insurance bad faith statute. You could contact a lawyer — or at least let LTD know you are considering doing so. That always gets an insurer’s attention. Request that LTD assign a case manager to you. That person works for LTD, but at least will be familiar with your situation, and can serve as a consistent contact for you. Keep meticulous track of all communications with LTD, and follow-up in writing. Best of luck.
AnonymousMarch 14, 2011 at 1:23 am
Hi everyone. Thank you all for taking the time to write and advise me. I went ahead and canceled the FCE due to several reasons. 1: my neurosurgeon and pain management physician was kind enough to perform an FCE and forward it to them. 2: it was scheduled for this past Friday, which would have robbed me of any possible time with my daughters (I sleep for days after physical exertion) 3. This is Spring Break week and if I want any hope of spending time with my kids, an FCE would most likely keep me in bed for most of this coming week also. I went ahead and emailed my LTD rep the FCE from my doctor along with a letter he wrote to him stating that disregarding his FCE, my past medical records, NCV’s/EMG’s, and all the records that the insurance company has on file for me is a blatant disrespect for not only his medical education and experience, but all of my current treating medical professionals who have diagnosed me and deemed me disabled. He said that his (the ins rep’s) bullying tactics of threatening to cut my benefits is uncalled for and unprofessional and he is requesting that the bullying stop now!
My LTD representative whom I have dealt with for over a year no stopped my benefits as of Friday. I sent him an email letting him know why I could not make it and he said that I have until Monday to send him all the information from my doctors including the FCE, which he had not seen yet, and doctors notes from a new treating phi that I have who has deemed me totally bedridden, due to the fact that I sleep for 3 days at a time.
I went ahead and sent all the new medical records, the FCE and the not so nice but true letter from my near. Now I guess we will just have to wait and see.
An interesting thing happened this weekend. It was the first weekend/Saturday I have felt well. I mean really well. I was able to join my husband for the first time in over a year in taking our kids to the zoo!!!! I was so excited!!!! My 5 year old went with my husband and my youngest daughter 2 weeks ago for the 15th time with me because I was in bed. When they returned, I asked how it went and she started bawling. I hugged her and just asked “honey, why are you so upset? Didn’t you have a good time”? she said “because it’s always daddy, Lauren and e. You are always in bed. No one even knows I have a mommy because you never come to my dance shows, or my karate classes, or any school trips. You are always in bed and I miss you so much”!
There are no words that can mend that kind of heartbreak in a 5 year old. I hugged an kissed her and assured her that mommy and my doctors are working as hard as we can to figure this out so that she won’t have to miss me so much and I wish I could be there with her at all of her functions, but mommy’s reality, for now, is my bed.
So yesterday I surprised them with a family trip to the zoo!!! I have been taking a new medication called Imunovir which has helped my energy level. Enough that I was able to join them for the first time, in a long time. Today, I paid the price and woke up at 7:30PM, but it was worth it!!! We had so much fun!! I had to use my cane, and we rented one of those big family rickshaw looking bikes thar my husband pedaled, but we did it!!!our first family outing in over a year!!!! My little girls were so happy and they did not believe I was going until I actually got in the family van! What a great day!!!
A perfect day for a private investigator to film me for my LTD company! Wouldn’t you guess it. I guess since they are making their decision up next week regarding my benefits, they have been watching me like hawks. It’s just funny how the first day I have a family day in over a year, I catch someone recording me. I wish they could have recorded me today in bed until 7:3pm and waking up only because of the pain I was feeling In a dream!
Oh well, what can you do right? I am happy that for once my girls didn’t feel abandoned by their mother and we were able to share a very happy day together. I am glad that I was able to Shia them the light that I am seeing on this CIDP journey and that the good days have to be taken advantage of!
I just hope I don’t lose my benefits for having one good day out of 365.
I will keep you all posted. Again, thank you for all your advice and taking the time to write and care.
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