Onceagain33
Active Member
NM
i have not yet decided if I will take further action, what that would be….or if I even could.
I have been getting injections into my knee of hydraulic acid for about 10 years. Every 2 years or so. It’s sort of like a slow leak flat tire…from time to time the joint needs to be pumped back up, When the bone on bone gets too bad…it is time to pump it up again. I know this is not a fix..…but, it is working for me…so surgery is not going to happen as long as this works, I said all that so you can understand I am no stranger to this procedure.
so…my usual Ortho is in Colorado…but I am not there, but in NM. I went to a local orthopedic to get this injection (not my usual up in Colorado). He told me that he wasn’t authorized to handle this admixture. I would have to get a prescription filled at the pharmacy. This would have cost me $2400 out of pocket….medicare will not cover it if it was not in the drug plan…which it is not. So, after discussing this..he told me that if I had this done by the pain management clinic at the hospital it would then be done by them and completely covered. He wrote a referral. So..I went there.
the shot was not properly done…he tried to get into the joint by going upward under the knee cap. Hands down the most painful thing I have ever endured. The pain did not subside. I could not put any weight on that leg. I remained talking with this doctor for ~ 45 minutes more. I was unable to walk, and in a great deal of pain. He ordered a wheel chair for me to depart. I called a friend to come get me as I could not drive.
the next day I was a total basket case…no sleep because of the pain…still unable to walk. I got a call from this doctor who told me he never saw this reaction before. I told him that my leg was swollen from the knee down to the ankle and I couldn’t walk. He then asked me if that meant I wanted to put off the second shot, What??? What second shot? This is not anything like I am used to. I called the orthopedic (the guy that wrote the referral) and told him I believe the doc at the pain management clinic did not give me the injection that was ordered. (the injection is not 2 shots involved) and anyway he missed the joint, Soonest appointment I could get was 6 weeks!
for the next 2 weeks I could not drive myself, and I couldn’t walk without the use of a rolling walker. I was more than a week before I could to sleep through an entire night. I returned to this pain management doctor for a follow up. I had to use a walker in and out of his office in the hospital. He pretty much just blew me off.
I called medicare and asked them to open an investigation into this doctor. They referred me to the company that does the medical review for Medicare. I filed a formal complaint.
well…they got the medical record. The doc didn’t put anything about the pain I was in while still in his office. Not a single mention of the condition I was in. Not a single mention of the lengthy phone call the next day. Not a single mention of the follow up appointment. I wonder if he cleanup the records after he was notified by Medicare or if he sort of thought I was going to sue and just left all that information out.
After about a month I was able walk again but then I could tell that I still needed this injection. I made an appointment with an orthopedics in a difference city 80 miles away (not going back to the Ortho here, and no other choices locally). The injection was done exactly like it is usually..and I walked out of that appointment pain free.
so…he we come to the crux of the matter. Medicare paid the pain doc. But…I just learned that Medicare will only pay for this injection once in any 6 month period. So..they will deny the claim from the doc who did the right job.
I get that the Ortho that did the correct job is owed payment. I’ll make some sort of deal to pay it off. Hopefully we can agree on some budget plan. But…I want that money back from the pain management doc …. He shouldn’t have been paid in my opinion, and besides that I had to get the injection a second time because he messed it up.
i can prove the phone calls with the pain management doc. Also, because this was a hospital during Covid …. Everyone had to enter and sign in at ER entrance only (other doors were locked). So..my entry is in the hospital logs….and I am sure they have security video that will prove the condition I was in entering and exiting….but, hospital will not allow me access to that to prove this. I also have that friend who was driving me around as a witness
the total bill is for $4658.
not sure what I can or should do.
i have not yet decided if I will take further action, what that would be….or if I even could.
I have been getting injections into my knee of hydraulic acid for about 10 years. Every 2 years or so. It’s sort of like a slow leak flat tire…from time to time the joint needs to be pumped back up, When the bone on bone gets too bad…it is time to pump it up again. I know this is not a fix..…but, it is working for me…so surgery is not going to happen as long as this works, I said all that so you can understand I am no stranger to this procedure.
so…my usual Ortho is in Colorado…but I am not there, but in NM. I went to a local orthopedic to get this injection (not my usual up in Colorado). He told me that he wasn’t authorized to handle this admixture. I would have to get a prescription filled at the pharmacy. This would have cost me $2400 out of pocket….medicare will not cover it if it was not in the drug plan…which it is not. So, after discussing this..he told me that if I had this done by the pain management clinic at the hospital it would then be done by them and completely covered. He wrote a referral. So..I went there.
the shot was not properly done…he tried to get into the joint by going upward under the knee cap. Hands down the most painful thing I have ever endured. The pain did not subside. I could not put any weight on that leg. I remained talking with this doctor for ~ 45 minutes more. I was unable to walk, and in a great deal of pain. He ordered a wheel chair for me to depart. I called a friend to come get me as I could not drive.
the next day I was a total basket case…no sleep because of the pain…still unable to walk. I got a call from this doctor who told me he never saw this reaction before. I told him that my leg was swollen from the knee down to the ankle and I couldn’t walk. He then asked me if that meant I wanted to put off the second shot, What??? What second shot? This is not anything like I am used to. I called the orthopedic (the guy that wrote the referral) and told him I believe the doc at the pain management clinic did not give me the injection that was ordered. (the injection is not 2 shots involved) and anyway he missed the joint, Soonest appointment I could get was 6 weeks!
for the next 2 weeks I could not drive myself, and I couldn’t walk without the use of a rolling walker. I was more than a week before I could to sleep through an entire night. I returned to this pain management doctor for a follow up. I had to use a walker in and out of his office in the hospital. He pretty much just blew me off.
I called medicare and asked them to open an investigation into this doctor. They referred me to the company that does the medical review for Medicare. I filed a formal complaint.
well…they got the medical record. The doc didn’t put anything about the pain I was in while still in his office. Not a single mention of the condition I was in. Not a single mention of the lengthy phone call the next day. Not a single mention of the follow up appointment. I wonder if he cleanup the records after he was notified by Medicare or if he sort of thought I was going to sue and just left all that information out.
After about a month I was able walk again but then I could tell that I still needed this injection. I made an appointment with an orthopedics in a difference city 80 miles away (not going back to the Ortho here, and no other choices locally). The injection was done exactly like it is usually..and I walked out of that appointment pain free.
so…he we come to the crux of the matter. Medicare paid the pain doc. But…I just learned that Medicare will only pay for this injection once in any 6 month period. So..they will deny the claim from the doc who did the right job.
I get that the Ortho that did the correct job is owed payment. I’ll make some sort of deal to pay it off. Hopefully we can agree on some budget plan. But…I want that money back from the pain management doc …. He shouldn’t have been paid in my opinion, and besides that I had to get the injection a second time because he messed it up.
i can prove the phone calls with the pain management doc. Also, because this was a hospital during Covid …. Everyone had to enter and sign in at ER entrance only (other doors were locked). So..my entry is in the hospital logs….and I am sure they have security video that will prove the condition I was in entering and exiting….but, hospital will not allow me access to that to prove this. I also have that friend who was driving me around as a witness
the total bill is for $4658.
not sure what I can or should do.
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