Monday, November 29, 2021

The Piper Appears With Palm Outstretched

We didn't get any mail on Saturday. I checked EmBee at 4:30 when I came home from town. Our mail used to get here by 1:00. Not any more! Last week, we also didn't get any Saturday mail, but The Pony said if we got any at all, it probably came after dark, so to check on Sunday. And there it was!

Anyhoo... yesterday I parked T-Hoe to walk across the blacktop county road and check EmBee. Hick was rolling down the hill in SilverRedO, and paused long enough in turning to smirk,

"Heh, heh! It's SUNDAY! There ain't no mail today!"

"We didn't get any yesterday, so it might be here now."


On he went, probably sad that the gravel road wasn't dry enough to leave me in a cloud of dust. I DID find EmBee's gullet full of mail. I pulled it out and turned to wave it in the direction of SilverRedO's receding tailgate. I hope Hick was looking in his mirror! I love to be VALidated!

Anyhoo... our mail contained two junk mail catalogs, three offers for Hick to switch his Medicare supplemental insurance, and one envelope for The Pony. It was not a letter.


You know, the ankle he broke while on the job delivering mail for the USPS. For which his Worker's Compensation claim was denied over a technicality of an Urgent Care nurse-practitioner's signature rather than a specialist's signature, and the absence of one form that he got the runaround on for over two weeks.

Anyhoo... paying the piper isn't the issue. It's HOW the piper will be paid.

The orthopedic practice has been more than accommodating. The ankle was broken on July 15. The Pony was in the soft half-cast applied by Urgent Care for TWO WEEKS before he could get the necessary form filled out to get an appointment with a podiatrist. 

One walking boot, two more appointments, two x-rays, and four months later... this is the first bill The Pony has received. It is coded as "current." The bill is itemized. Everything listed is care that The Pony received. The Department of Labor was billed in October and November. Paid $0.

The orthopedic practice is certainly entitled to their fees. The last time The Pony was there, they filled out a form for the specialist's signature and pertinent details of the injury. The Pony told them he needed it to file for a RECONSIDERATION on his claim, which had just been denied and closed. The office representative said this happens a lot, and they would keep trying, no need to pay anything at that time.

Here's the thing. Insurance won't pay for a work injury. It's considered insurance fraud (by The Pony) if they pay, and then he gets a Worker's Comp claim settled.

Hick says that if The Pony pays, the orthopedic group will stop billing the Department of Labor, because the bill is paid. Then the DOL won't ever pay. That The Pony would likely have to sue them to get his money back for the medical bills he paid.

It's not an issue of the money. The Pony brought home the amount of the bill in one week on his last pay period. Sure, nobody WANTS to spend their hard-earned money on a doctor bill, but it's in his account, and it's not a hardship to pay it in full. But he WAS injured ON THE JOB. The USPS has never disputed that fact, and sent in the corroborating paperwork confirming the on-the-job injury.

The packet with all the forms for the RECONSIDERATION was mailed on September 17. The Pony finally got confirmation from the DOL that it was received on October 12. Right now his claim is being reviewed. Reconsidered, if you will. So the claim is technically OPEN, and not yet resolved.

I say The Pony should take the orthopedic group a copy of his DOL letter saying his case is being reviewed. That way, they will have confirmation other than The Pony's word for it. They might put a letter in the file, and keep billing the DOL until the case is resolved by payment or official denial.

The Pony is taking the bill and the DOL letter to discuss with his shop steward, and if she isn't available, with his new acting manager, for advice on how to proceed. I doubt The Pony is the only beast of mail burden that this has ever happened to...


  1. Wrestling with Workman's Comp, and Insurance? Good thing he is young.

    1. Yes, good thing he is young, because he will grow old waiting on a decision from the Department of Labor!

  2. And the saga continues. Will this ever be resolved or will it get made into a long running TV series? Titled "Bureaucracy At It's Worst"
    I really thought all that had been sorted and fixed by now.

    1. I'm pretty sure it will SEEM to be resolved, and then another monkey wrench will come flying out of nowhere to clog up gears, and hopefully not hit The Pony on the ankle!

      On Tuesday, The Pony is taking the orthopedic group a copy of the Department of Labor notice that they received his paperwork and will start a RECONSIDERATION.

      His shop steward let out a few expletives, as she does when faced with such preposterous examples of clustercluckery, and said, "I'd pay them $25!" The Pony was not sure if she was serious or not.

      The Pony plans to pay in full if the orthopedic group says they need some payment now. He figures it will be easier to fight to get one lump some back, rather than numerous installment payments.

  3. If he collets from his insurance and then receives workman's comp, it would only be fraud if he does not pay the insurance company back. I think he should file with a note that there is a pending workman's comp claim.

    1. Your advice is too late to share with The Pony. He paid his bill in full today. The orthopedic group agree that it would be easiest for him to be reimbursed by the DOL than to drag it out waiting for the decision, or with installment payments. Heh, heh. It's not like they are an impartial party in this mess! They got THEIR money, case closed. However, I DO think they've been more than fair in trying to deal with the situation.

      I don't like to think of dealing with TWO entities to get it straightened out. The DOL is enough, without adding an insurance factor where you can never reach a real person when you call. Or the same person twice.

  4. Apropos of nothing, other than my wacky brain, The phrase Mr. T used so frequently ppped into my head. "I pity the fool ... who has to deal with th DOL." I have no idea where that thought came from!