Retired pharmacist and chronic pain advocate Steve Ariens has some tips for chronic pain patients in fighting their insurance companies.
Some believe that it is primarily to help boost their bottom line profits, while others believe that it is an effort to head off being sued by various cities, counties, states and others … like they are now suing the numerous pharmaceutical companies and pharmacy wholesalers. The practice of medicine has some rather simple basics. Once that exam has been done the prescriber then can legally proceed to develop a patient treatment plan for the patient.
This article will focus on those, but there are many similar paths that a patient can take with the other health insurance policies. Your Medicare drug plan will send you a written decision. If you disagree with this decision, you have the right to appeal. There are links to South wales evening post dating narcotic prescriptions details of these appeal processes.
If nothing else, tell them that you want to get to the next appeal level if they are not going to pay for it.
Knowing that a patient is going to be aggressive in the appeals process, may get them to give up and approve the medication. They know that the farther the patient takes the appeals, the more likely they will get approved and they will have to pay for it. The doctor has a role to play. Of course, the medical director has not done a in person physical exam on the patient the patient is simply a name on a computer screen and quite likely does not have a license to practice medicine in the state in which the patient lives.
It may also be appropriate to file a grievance with www. I have no confidence in the DEA looking at the issue that the insurance refuses to pay for the controlled medications before they could consider taking actions against the patient, prescriber, pharmacy involved.
If they do, keep a copy of the reimbursement for the appeal process to show how inconsistent their policies are. Enter your email address to subscribe to this blog and receive notifications of new posts by email. I recently was let go from work. I have been disabled since I recently had to go to a new doctor after I found out my GP never told me about being anemic for a year and a half. The new doctor cannot find out 27 years of my health because I do not even have enough time to get through what I have to.
I had called the prior authorization girl twice and she never called me back. She tells me that the insurance company refused me cutting down my pain medication and wanted prior authorization. She guessed because she rather is wrong than calling the patient back. My issue is that these people are hurting my health. The insurance compy wants proof of everything but who keeps papers as long as I have been disabled.
Although when HIV first came to be known the doctors were asking the patients questions so they may be able to understand how and what the virus did and felt like.
We as patients were very close with our doctors and the bottom line was we trusted them and they trusted us. I found out because I started to search my blood record for what might have been causing me vertigo when my doctor ignored me 5 straight months of complain o him and he did nothing that when I went to the blood tests and "South wales evening post dating narcotic prescriptions" I found out I was anemic.
I reached out to my oncologist and asked him for a blood test after explaining to him what had happened. Drew…He said oh I know him he is a friend of mine. When my oncologists South wales evening post dating narcotic prescriptions called me she told me I was no longer anemic.
Sorry off subject but I needed this to get out. Deborah, It is always a good idea to have a copy of these documents in your possession. If you have a pharmacy card, call the on the back.
They should have a record of the PA. The insurance companies who are always complaining about how much money they are losing, when in fact they are a TRILLION dollar a year industry, yes I said a trillion.
Somebody needs to investigate that part of the equation. The trouble is, the people that can investigate are the people who are getting paid off by the lobbyists so then what are we chronic pain patientsto do? I hope every suicide committed by a chronic pain patient gives these congressmen and senators nightmares, what a horrible thing they are doing to their fellow Americans, shame on every one of them.
But sadly money always rules the day and when you have the money and you have the title, power over the people is what you end up with. All we can do is keep on screaming until someone volunteers to be our champion, South wales evening post dating narcotic prescriptions then we have to try everything, make a lot of noise, get important people to help us. Do you think that a millionaire who has chronic pain is going to go without pain medication? The answer is obviously no, think about that.
Keep up the good fight, never give up, never surrender!!! Thank you for this article. A few tips for others: Your Doctor may not be able to put in the time to get it done without your help. I spent more than 1hr on the phone, which in my condition was extremely trying, but I made progress. Do not take no for an answer. A manager can give you this information if the person initially refuses to provide it. Severe Abstinence Syndrome can be life threatening.
They already know its a medical necessity, that it is urgent, and that removing you from a medication you have been stable and maintained on is not only morally and ethically wrong, it is legally wrong and is likely to adversely affect your health. Sharing this experience makes me nervous but the more people who give in make changes, suffering through unnecessary pain and side effects due to these policies then the easier it is for insurance companies to implement them.
I saw an article somewhere saying many of these companies, under the guise of trying to help safeguard people and patients, have actually been cutting the LESS addictive expensive medications rather than the cheaper more addictive substances. If accurate, that sure makes this look less like compassion and more like a money grab.
I have been on the same pain medicine for 15 years. I have many problems with RA, herniated discs, stenosis, radiculopathy, sciatica, scoliosis, fibromyalgia among others. I already had a PA approved a few months ago good for a year. They claim they could not find it.
I had my meds filled for these two meds for years until this month. All of a sudden my PA is missing and I now need a new one! I am on my very last day of medicine and you cannot go without this medicine without going into withdraw and severe pain. What can I do legally to my insurance co for endangering my life?
I told the Insur co Bluemedicare that I will be suing them. I told the Insur co supervisor that I have no meds left and will end up in the hospital.