AB-
I have finished my letter. It and the supporting documentation weigh almost
12 ounces. When I find time to scan all the other documents, the whole thing
will be available on my site.

Thank you to all for your continued support.

KRS
Krstofer Evans

http://krstofer.org/
http://crew13.com

Here's the letter:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
19 Jan 2004

Mrs Galli,

I have several concerns with the Federal Office of Workman’s Compensation. They
have apparently decided not to reimburse me for medical equipment I have
purchased, not to pay for travel to doctor’s appointments, and are rather
glacial when it comes to authorizing any new treatment or equipment, if such
gets authorized at all. Also, if my medical bills get paid at all, it takes long
enough that I get collection notices.
Here’s my story, just to bring you up to speed with what I have been dealing
with:

I’ve been disabled now for a little over two years. Fortunately when my “season
ending event” as we called them happened, I was at work as a Sawyer for the
Plumas Hotshots. If you’re familiar with the "Herger-Feinstein Quincy Library
Group Forest Recovery Act" then you may know where Quincy is, and where we were
based. Being a national resource, we could be called to anywhere in the nation
at any time to help with any sort of disaster. We were trained to deal with wild
land fire, and that’s what we almost always did. The season starts in May, and
we’d been all over that year. It was getting cold, and frankly, with 1000 hours
of overtime almost in the bag, I was about ready for it to be done.

Then we got a call on a Friday, that we were going somewhere the coming Monday,
so stay close. Come to find out a bit later we were being sent to Kentucky. I
did not really want to go, as we had been watching the large fire report, hoping
for one last “big one”. Nothing was burning in Ky, and from what we heard of the
place there wasn’t much potential. What we didn’t know is that apparently the
big thing to do in southeast Kentucky around Halloween is to get some beer and a
handful of bottle-rockets, get drunk and torch the woods. It had been a dry
fall, and Region 8 was expecting quite a bit of hoodlum-ism, so they ordered 10
Hotshot Crews. We were one of ‘em. We drove to Redding, loaded all our loot on
an aircraft, and went.

On our 2nd fire of the roll, the Poplar Log incident, we were almost done. A
bomber had hit the last side, pretty much exterminating the fire, and I was
following the edge, cleaning out little trees and such when a Black Locust snag
a ways in the burn fell. It came down from behind me. Half the crew saw it and
tried to warn me, but with earplugs in, a live saw, and my back turned, I had no
chance. It hit me right over the head, a thump of which I have no memory. I woke
up 2 weeks later, in a hospital somewhere, having no idea what happened.

Here is an account of the event written for me by Ryan Bauer, in his own words:

My view was probably no more frustratingly good than anyone else’s. From upslope
of you, very near Tolen, I saw the trees first movement along with others and we
all called it out. The guys on the lower bench, just above you, who heard us
started yelling, but as is always the case with a snag or rock, not everyone
heard the yelling. (As usual E.A. didn't hear a thing until it was all over
with.) As far as right after the accident; when I got there your legs had
collapsed first, then once you hit the ground you slumped forward and then over
to your right so that you ended up with your body wedged under the small tree at
about your waist with your knees under you. You were taking deep wheezing
breaths, really slow, but at least we knew you were fighting to stay alive. We
waited until we got all of the EMT's there to move you and get your airway
opened better. We cleared out the area to your left with tools, cut your gear
off, and rolled you onto it on your back. You were pretty beat up as I'm sure
you've heard, but the roll went really well and once we were done we put JP in
charge of the scene. Once you were rolled over you started to talk. At first all
you were saying was "help" and "help me", but as your consciousness increased
you started talking more and more. While you still had a lot of adrenaline in
your system you were pretty coherent, but as it wore off you started slipping
and getting combative. As far as your injuries, we were just assuming the worst
pretty amazed you were still alive. When Jeremy was doing his secondary survey
you let out one hell of a yelp as he palpated your right leg but we weren’t sure
if it was your leg or just the pain in your back increasing. Anyway we were
pretty sure your leg wasn’t broken as it wasn't unstable at all. As we went on I
asked you to push down on my hands with your feet, and after we got you to
concentrate on it you did move your right foot but I lost your attention after
that and wasn’t able to get you to try your left leg. After that the medics
arrived and after what seemed like forever we decided to carry you to the skid
road, 4x4 you to the ambulance, run you down to the elementary school and fly
you to UK. The hike to the skid took probably 20 or 30 minutes and if it was
rough its because the FS Paramedic and I were carrying the tail end of the
backboard and couldn't see the ground much less our own feet. Hope you didn't
have to endure any extra pain on my account. 

Upon examination in the ER, it was found that I had 15 broken ribs, broken left
scapula and collarbone, smashed brachial plexus, collapsed left lung, lacerated
spleen, torn right PCL, concussion, and a burst fracture of thoracic 4 and 5,
damaging my spinal cord and resulting in paraplegia. I spent a month in the
neurological ICU at the University of Kentucky’s Chandler Medical Center. They
put me in an induced coma for the first two weeks, as I was a bit combative.
On the 5th day my neurosurgeon decided she could wait no longer to stabilize my
spine. The concern was I had contracted a staph infection in my lungs (as if all
the other injuries weren’t enough) and to do the surgery I had to be in a
facedown position for 6 to 8 hours. The added pressure on my lungs might kill
me. She went ahead, as the benefits outweighed the risks, and after spending an
hour picking bone fragments out of my spinal canal, implanted two titanium rods
from T1 to T10 to stabilize my spine. I will now set off metal detectors for the
rest of my life. 

After my stay in the ICU, I graduated to Cardinal Hill Rehabilitation Hospital
in Lexington, KY, where I spent 2 and a half months learning to pilot a
wheelchair, get in and out of bed, and care for myself in general. Due to the
brachial plexus injury, I had extremely limited use of my left arm, and two
pounds of grip strength in that hand. By the time I finally got home in April, I
had a grip strength of 200 pounds in the left, and 175 in the right. “Normal” is
around 50 pounds.

Around February 15th, it was decided I should move on to another hospital for
further rehabilitation. Craig Hospital in Denver and Shepherd Center in Atlanta
were the candidates. Mom flew to each, on the federal dime, to check them out
and make a decision. Craig was the winner, and an air ambulance was authorized.
I ended up flying commercial, as I was stable enough to make the trip on my own.

While at Craig I became an expert wheelchair pilot, learning wheelies, how to go
down stairs, and the mechanics of getting straight off the floor and back into
my chair, a feat I still cannot accomplish without a stool or something. I
pressed on toward full independence, living alone in my own room, with nurses a
panic button away. 

A van was purchased for me, and fully modified with a drop floor, wheelchair
lift, hand controls and a 6 way adjustable seat so I could drive my own self to
school, adding to my independence. I was surprised when I got a phone call
asking me what color I wanted, as I wasn’t aware I had any choice at all in the
matter. While the van was being modified, OWCP provided me with a rental so I
could get around on my own. I enrolled in the local JC, Feather River College,
and completed my Associates.

For those first 6 to 8 months, it appeared that money was no object relating to
my care. I should have been evacuated to a hospital in Tennessee for care, but
it was decided that University of Kentucky was better equipped, but a 45-minute
flight in the other direction. A month in the NICU ran $163,000. A $30,000
surgery, and two and a half months at Cardinal Hill, at $1,000 a day just for a
bed. An air ambulance was authorized for the trip to Craig. I have no idea what
the price tag on that adventure would have been. Then two months at Craig, one
of the best spinal cord injury hospitals in the world.

>From the Craig site: “Craig Hospital is designated by the National Institute on
Disability Rehabilitation and Research (NIDRR) as a Model System Center for both
SCI and TBI. Craig has been ranked in the Top Ten Rehabilitation Hospitals in
the nation for 14 consecutive years by U.S. News and World Report, since the
ranking began in 1989.”

My parents were flown to Lexington to be near me during my stay there, and set
up with an apartment, and rental car, and meals for the duration. Again, the
feds paid the bills.

It appeared that nothing was too good or too expensive. Then I returned home,
began dealing with OWCP, and the fun started.

Rather than deal directly with me, OWCP hired a rehabilitation councilor in
Reno, Susan Trist, to assist me. I was told to buy the small medical things I
required, save the receipts, and then submit them through Susan for
reimbursement. For the larger items ($1,000+) we asked OWCP for authorization,
received it, (rather easily, in hindsight) purchased the items, and submitted
the receipts.

To my knowledge I received no reimbursements until November of ’03, when I
finally received a check for $360.50, which is about 5% of the total I am owed.
OWCP claims to have sent a check for $3,048.43 on the 18th of September 2002,
but to my knowledge I never received it. I’ve checked with my bank, and no
deposits of anywhere near that size were recorded. In August of 2003 we asked
Mr. Hooker (of the SF OWCP office) to run a trace on it, which he said I had to
submit in writing, which I did on the 14th. I have heard nothing about it
since.
I traveled to Craig Hospital in May for a weeklong re-evaluation of my injuries.
Travel was authorized, so I went. Upon my return, Susan and I submitted a travel
voucher, which was denied, as I had left from an “unauthorized location”. 196
Sylvan Way, Quincy, Ca is both my military and civilian home of record. Please
see included DD 214 and Social Security correspondence envelope attesting to
this fact. Susan has resubmitted the forms with a letter explaining the
situation, which I have included. Someone paid the doctors there, I hope, so I
wonder why my travel expenses were not paid.

On November 15, OWCP contracted all reimbursement out to a company called ACS. (http://owcp.dol.acs-inc.com/portal/main.do) I had hoped this would make
reimbursement a little easier, but as I would come to find out, even more
reindeer-games were just beginning. With this new system, and because Susan’s
job is to help me get started and not be my personal liaison for the rest of my
life, I have begun trying to submit my travel vouchers and receipts through ACS.
Almost all so far have been denied. I have attached 3 of what appear to be
denial explanation letters or something. Everything on them is rather cryptic to
me, as they appear to be using ACS internal numerical codes. About the only
thing I understood on the whole form was the word “DENIED”. What was denied? I
have no idea. 

Now I can go to the above mentioned ACS site, and after typing in my social,
birthday, and a few other things, get into a zone where I can check on
reimbursements in 30 day segments. I have printed and included a page of this
information for you. As you can see, the billed amounts usually don’t match the
paid amounts. Who billed the amount, for what, and when? It’s impossible for me
to tell. I clicked on #1, TCN ending in ~3801, and as you can see (I printed it
and included it as well) there is absolutely no information whatsoever on that
page which is useful to me.

The challenge for me now, and Susan with all the previous submissions, is
figuring out (when, if ever, I get paid) what exactly it was I was reimbursed
for, and what was denied. Not knowing this makes it rather impossible to attempt
the resubmission of anything, nor to know how much money I am still owed.
As I attempt to submit my receipts, apparently I am to use a form CA-915,
(included, blank) which I did, and which were denied, as I did not submit the
proper CPT codes. I checked the form, and there’s no column for such code, the
meaning of which I had to look up. Apparently it’s an “American Medical
Association's Physicians' Current Procedural Terminology (CPT®) code”. I have
not been provided the book containing said codes, but they are available online
at http://www.medicalbillingworld.com/CPT/cpt_pmicprof_spiral_2004.html for
$77.97. I am in the process of trying to contact someone at OWCP in order to get
authorization to purchase said book, so I can submit the correct codes. Written
in the margin of the form, I guess.

Not only have I not been paid, apparently my doctors and other providers are
having a hard time getting paid as well. I have received a collection notice for
services from North State Radiology, in the amount of $281. On 10.30.03 Dr
Gilman sent me a bill for services provided on 8.7.03, as they had received no
response from insurance. Plumas District Hospital continues to send me updates
to their attempts at billing. Apparently there is still a charge of $277.20
outstanding from 11.6.02. That’s over a year ago. Recently, they have begun to
add amounts to the “You Owe” column. On the North State Radiology bill, the
charge emanates on 6.24.03. No wonder they have sent me off to collections. My
dentist has also been sending me bills, which I have been forwarding to OWCP.
Come to find out last week, after several denials of the charges, that OWCP will
not pay for maintenance, as the charge was for a cleaning. I have decided I will
pay for this one, rather than get into another fight.

On 3 December I went into Rite-Aid to pick up my monthly pills. Oxycontin,
percocet, neurontin, celebrex, ditropan, and baclofen, plus a dose of
erythromycin, as my girlfriend had recently contracted PID, and the doctor
wished to treat us both. He didn’t want us transferring it back and forth to
each other. Rite-Aid billing refused to authorize the prescriptions, as it had
been too long since my insurance (OWCP) had paid them. The first 4 of those
medications are painkillers, which I must take every day. The last two are
antispasmodics, as with a damaged nervous system, the parts of me I cannot
control like to go off and dance with themselves at times. Trying to sleep while
this is happening can be rather annoying.

When the pharmacy informed me of this … Discrepancy, I immediately called
Susan, and through some magic, she fixed the problem and I was able to pick up
my medications in a few hours.

I have received one other check, which came shortly after my first receipt
submission to ACS. Frankly, it surprised me with how fast it came, or so I
thought at the time. “These guys rare on the ball” I thought rather excitedly.
Susan and I talked about it, as upon inspection it appeared to have been sent to
me erroneously. Come to find out about 3 weeks later this was the case. It
should have gone to Rite-Aid, and the feds wanted it back, right now. I have
included a copy of said check and the letter. At least they are trying to pay
someone, I thought.

Many of these reciepts were charged on my credit card, which now carries a
balance of some four thousand dollars. I put these charges on said card when I
still had the belief that I might see the money, someday. Am I receiving an
adjustment for the interest I am being charged? No. To put myself in the shoes
of OWCP, had I not paid someone I owed for this long, let’s say the IRS for
example, I bet “Men in Suits” would have been at my door long ago demanding
payment. Not only would they want what they are owed, but they would want it
with interest. Unfortunately, I have no such recource. 

Not only am I having trouble getting things authorized, it seems my doctors are
having a hard time as well. Dr McKinney, my current primary care guy in Oroville
is trying to get me a powerchair. (Please find his card included) Now I don’t
know the whole story, but from what the receptionist tells me, one person at
OWCP authorized it, but then another denied it. Then it was authorized again,
but now we’re apparently playing the “There’s a limit to the amount we’ll pay
for this” game. Now I can understand they aren’t interested in paying tip-top
dollar for a chair, but from what I understand most powerchairs range in price
from 5 to 7 thousand dollars. That’s just what they cost. I don’t set the price,
and neither does the doctor’s office. If it’s truly authorized, then let’s get
it done.

The same doctor is trying to refer me to a pain specialist. Strangely enough,
all the parts I cannot feel hurt, most of the time. I spend too much time in my
wheelchair, my lower back begins to hurt. If I sit in my easy chair for too
long, my legs begin to hurt. The only relief I can get is either from multiple
percocets or laying in bed. By the time I eat enough percocets to kill the pain,
I find myself too dumb to do anything, while laying in bed lets my mind race,
and I still can’t do anything. I would really like to go see this guy, and I’m
beginning to wonder exactly how long the authorization might take. If
authorization for the ICU or surgery in Ky took this long, I’d be dead now.
Manual therapy was prescribed 24 September 03, and I finally got authorization
on 4 November. A month and a half of torture, as the ligaments in my left
shoulder tighten up, making it quite painful to push a wheelchair. 

I currently travel 280 miles a month round trip for one trip to my doctor in
Oroville, and 4 trips to manual therapy in Corning. Shortly I will be submitting
a travel voucher, and I expect it to be denied. We’ll see, but if the visits are
authorized and (I hope) being paid for, how am I supposed to get back and forth?

My concern is that more as time passes. OWCP and ACS and whoever else comes
along will continue to find some reason why they don’t need to pay me, and the
receipts and travel vouchers will continue to be denied. In order to get away
from the “denial of receipts” type game, I have begun ordering everything I can
through a local medical supply house. “Let them figure out the forms” I decided.
Hopefully I can make this work, and continue to get all the things I need
through them. I’m not holding my breath, however, as with the OWCP / ACS track
record, I expect to begin receiving bills with “No response from insurance”
noted on them sometime next summer.

Please, if you could, find out what is happening with these reimbursements, and
what can be done to not only get me what I am owed, but keep all my providers
paid and happy in the future. Also, I have asked for and have not received some
sort of written schedule pertaining to equipment replacement. My wheelchair
tires wear out about every 4 months, I replace them, submit the reciept, and (as
I have discussed) nothing happens. My wheelchair will wear out as well, and so
will my van. As at this point, with current medical knowledge, I will be
disabled for the rest of my life. (and with my luck, it will be a long one)
Sometime in the future I will need to replace those two pieces of equipment,
along with my elevated toilet seat, shower chair, pressure-relief mattress, and
I’m sure many other things I cannot think of right now. I would like, if
possible, to have a written list of when I might ask for a new piece of
equipment, and expect not to be denied.

Thank you for your help in this matter,

Krstofer Evans