AndyDufrane

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Sep 6, 2003
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so my office gets phone call from a local hospital's trauma service asking if we take care of brachial plexus injuries, we said sure, saw the patient 2 months after her MVA where she has pain and paresthesias in left upper limb, the outside records indicated Cervical CT wnl, working dx cervical radic vs brachial plexus injury, now this is a patient who had 2-3 other MVA in the last 2-3 years, I did the emg, and sure enough, brachial plexopathy, I did see her once after EMG, she was feeling better, there was never any motor deficit, just sensory loss in medial forearm which was also improving, but this lady just gave me a funny vibe there was more to it, she had already been going to PT at the hospital system that referred to us, so I started her up neurontin and NSAID, then she no shows for the subsequent 3 appointment, then calls our office this week after several weeks, to see if I would be willing to write a script for PT, oh, by the way, all of her auto insurance was used up covering the other hospital's expenses, and I do believe she is in litigation, so am not sure if she has already had PT, and not having seen her for several weeks, is it reasonable or not to send her for PT or should I just to make sure to cover my bases?
 

Gauss

Damnit Jim!
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Mar 3, 2002
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if the auto insurance part is used up you can switch to her private medical insurance for reimbursement. assume all MVA's have a lawyer and treat accordingly. In this instance, she has no showed 3 times so you'd be wise to discharge her from practice. No followup means you get nothing.
 
Jul 17, 2009
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Step 1. find out who's paying the bills now. If the answer is "Oh my lawyer says to just schedule any appts or PT that are medically necessary and he'll take it to court to get it paid" RUN
 
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AndyDufrane

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well, i am a hospital based employee, but I think the lady doesn't have any insurance, the only thing was auto which seems to have been used up prior to her getting dumped into my clinic
 
Jul 17, 2009
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I don't actively treat anyone once I know they plan to never see me again. Because treating relationships cannot be one sided, with you doing all the Rx and PT scripts and phone calls, with the patient refusing to come in the office to give you in-person feedback or allow you to re-examine them.

Ask for a followup office visit because it's been 3 months. If she shows, then treat accordingly. If she can't afford it and is a nice lady, then I would kindly give her some general advice like ice packs, home exercise sheets which you can mail her, and OTC pain meds according to the directions on the box.