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Contracts in the USA - can someone [easily] explain them to me please?

SueDSSueD Posts: 545
edited 06/11/2012 - 8:52 AM in Chronic Pain
I've read a few posts involving 'contracts' with doctors in the USA.

Please forgive my ignorance, but I just don't understand how they work. I think I'm so glad we (in the UK) don't have these to deal with. They sound really restrictive, confusing and legally? binding, with not much room for 'flexibility' or 'freedom' from what I've gathered so far. Is this true?

I know alot of people moan about the National Health Service (NHS) in England, but, when it works, it's brilliant and you cannot fault it. You can choose to see whichever doctor you wish, have second/third opinions, choose where to be treated etc. etc, though the downside is usually that you need to know in advance when you're going to be ill (sounds silly I know) as it can often take a few days before you get an appointment. Also, if for example, you're on holiday and become ill, you can usually visit another doctor in that area to be examined and be prescribed necessary medication without being penalised for it. From what I've read on the forum, this sometimes doesn't seem to be the case in the USA. I presume you can visit any USA Accident & Emergency Department in the country, like we can, but how does this affect your 'contract'?

It doesn't sound like patients in the USA have that much freedom and that sometimes you can only be treated by a doctor if you have a contract with them. And what happens to you if you don't have a contract, will no doctor treat you? It all sounds very confusing and could be a little bit worrying (in certain situations I'd think). I hope this practice NEVER comes to the UK!

If you're willing to tell me, I'd be interested to find out how your contract system works so I can understand it better (in very simple terms please!). Do you think it's a good/bad system - has it helped/hindered you?
2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!


  • I wish I had a copy of what I signed so I could give you specifics, but basically when one is being prescribed narcotic medications, the doctor asks you to sign an agreement that you will not have narcotic meds prescribed by anyone but that doctor and you also indicate which pharmacy you will be using and agree to only fill at that pharmacy, otherwise you just notify your pain mgt office if you change. You also agree to submit to periodic urine tests to check that your levels are consistent with your prescription. I guess in that case they are testing to make sure you are taking, not selling, your meds and also that your levels aren't too high and only indicate the medications you are being prescribed.
    I really can't remember the rest of it, but it is a lengthy document.
    Hope that helps. I'm sure others will provide more information.
  • You do take your medications in at each visit and they are subject to being counted. My doctor has never counted my pills but I fill in the count myself and show them the bottles when I go.

    I also wanted to add that I have not been offended by this policy at all. They are trying to avoid abuse. You can cancel the contract and change doctors at any time and you choose your own doctor (at least my insurance allows me to do that).
  • Not all doctors in the US require these contracts. I have been lucky and never ran across this myself. I have been asked to bring meds in after a surgery but nothing happened with them. I can say i have been with the same doctor for 3 years never called wanting more meds or needing anything between appointments. If I go to the ER he does need to know. Which if I am in the ER for pain, then something is wrong and my surgeon will be involved.

    I think the contracts are all in according with how much a doctor wants to in force them. I also think it depends on geographic location. Are problem here with drugs is not prescription meds but rather meth and crack. So most of drug in forcement has their hands full with rolling meth labs in peoples cars.
  • dilaurodilauro ConnecticutPosts: 9,856
    As Tamtam explained, not all doctors require this contract. With all the various doctors I have gone through in terms of surgery and flare ups

    I believe a lot has to done with trust and confident in one another

    I've been seeing my physicist now for about three years
    and there has never been a question about a pain contract. I know that several others that use this same doctor ARE required to comply to the contract.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I've never been asked how many pills I have or had to bring in my bottle to have the pills counted. You can find a sample of the contract on line. Google FDA doctor patient contract and you'll find some samples. Basically, it tells you that the drugs most likely won't take away all your pain. You understand that if you OD on them, they will most likely stop your breathing and you could die. You agree that you will get the meds from one doctor and fill the prescription at one pharmacy. There are some folks who will "doctor shop" and get several doctors to give them a prescription and then fill the prescriptions at different pharmacies so they can get more and more pills. I think this is more the case in people who are scamming and selling the pills rather than people who really need them for pain. My contract was just like this, very straight forward and, I believe, reasonable. I had absolutely no problem signing it.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • These contracts you are hearing us discuss is used with the Dr who is prescribing our pain medication/s. The contract varies from Dr to Dr., and what one persons says, anothers might not. The contract is the Drs way of protecting him/herself against a non-compliant patient who might otherwise decide to bring charges against, or make life difficult in some way for the Dr who has decided to discharge a patient for non-compliance of the contract. The reason some people take issue with the contract is because it tends to make a person feel as though they are not trusted. If the patient is taking their prescription(s) as prescribed, there is no reason to worry about the contract or to get caught up in it, but it is very important to take it seriously. Some things that may be on a contract.

    1, You may be asked to bring your medication in for random pill counts.
    2. You will be given random UA tests.
    3. Always tell any Dr you go to that you are in PM and never accept opiate/opiod medication from another Dr.
    4. If you need to go to the ER, tell them that you are in PM, give them the information and what medication you are taking.
    5. Do not give or sell your medication to anyone-if you do and we find out you will be discharged immediately and law enforcement may be notified.

    ...things like that...

    And it sounds scary, but it is basically common sense, except the other Dr or ER stuff, which a lot of people may not know it is illegal to get basically the same medication from different Drs., and that a person can actually get into trouble for that.

    I often read posts where people get the opinion that we (US) are pretty restricted and not free to choose Drs and such, and I think this is a miscommunication. We have choices, but a lot of times based on insurance(s), we might have to stay within a certain HMO or "group" of Drs (of which there are usually many in different areas). Also, because it's not free, we tend to complain a lot-I think-sometimes-lol. But we have choices and when it works, it's awesome..but our healthcare is very expensive.

    Anyway~~The contracts are not that big of a deal really. I think it's more of a moral thing, and yes that is huge, but not in the grand scheme of things.
  • Sue,

    Think of it like a 'gentleman's' agreement. The doctor and you are agreeing on who prescribes opiates or narcotics, and you as the patient are saying you will do as prescribed, and only by that doctor. It gives the doctor an "out", such that if you take more than prescribed, or less, he can drop you as a non-compliant patient.

    I've only run into one, and I refused to sign as this doctor was for an IME, and therefore I had no interest in prescriptions from him. My GP is my PM, and she doesn't test (except for liver, kidney function), and she's never asked me to bring in my medications for a pill count.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I now understand your system a little more and realise that your contracts are in place to protect you and your PM (is that Pain Management???). I can see where it could be open to abuse if left unchecked.

    So, your PM (the people who prescribe the opiates) is different to your doctor then in some cases?

    Suppose you were on holiday in a different State, had raging back pain, couldn't move, couldn't do the travelling home, nearly out of meds, and you went to A & E, you would HAVE to tell them about your contract (who with and where), yeah? Would they still be able to give you pain meds, sufficient until you get home, or would you have to wait, in agony, until you saw your own doctor and/or PM?

    Just curious.

    It's like the heavy fog [in my brain] is lifting a bit more, thanks!
    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
  • Sue,

    Yes, you understand correctly, PM = Pain Management doctors. Me, I am with my General Practitioner for my medications - no contract.

    If you are out of state and something happens that negates you needed additional pain management, it would be no different than visiting your local ER. You would advise them that you have a PM, *&* are under a contract.

    Many PMs give you a 24-48 hour window to advise them of what is going on. Others need the treating physician to at least leave a voice mail as to why he/she needs to give you opiates or narcotics, and then you would follow up during regular business hours. If the parties make the appropriate contacts, normally there is not a problem. So no, no suffering. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I do not know if you have Pain Management Clinics in the UK. Here we do....they only treat chronic pain, nothing else.

    If your PC Doctor can't get your chronic pain under control they will refer you to a Pain Management Doctor. You will still keep your PC Doctor for all other health problems.

    It is the Pain Management Doctor that requires you to sign a contract.

    My PC Doctor treats my chronic pain with oral pain meds and has never ask me to sign a contract. I do not have a PM Doctor.

    I hope this helps and does not confuse you more.

    Cheers :H
    Patsy W

  • due to hassles from the DEA, drug enforcement agency, in this country, the drs feel under the gun. the DEA oversees all narcotic scripts and who, and how much are given out. If they feel a dr is overstepping his bounries, they can be investigated and worse case, they can lose their liscense. To protect themselves from the DEA, some feel that a contract will help protect them. A contract is legal and binding and if a patient goes against it or even if a dr does not like what a patient does or says, he can drop them with minimal notice. Mine does not require urine or blood test or pill counting at least with me. I don't know what he would to with me or someone else if he felt i was cheating. maybe start with the urine and pill count. but at least for now all i agreed to is to only get narcotics from him and to notify him if i got them from someone else. i had surgery for gall baldder and the hospital put me on pain pump for a week. i let them know i was being treated by a pain guy but nothing happened. one time i did not tell hospital and i got chewed out by the nurse. why didn't you tell us that you were being treated by so and so? i said i was going to tell but things were so chaotic i did not have a chance now. so it depends on the dr but it is basically for protection, from patient and also from DEA. DEA are reall jerks sometimes. my dr is always complaining about them. another pain ddr i had forgot to fill out one form and had to attend a clinic for s few weeks about proper bookwork. we are not supposed to be treated as addicts and pain drs are not supposed to be treated as legal drug pushers, but some in the DEA feel that they are and so are we. i hope this helps
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Now I undertstand about your 'contracts'.

    In the UK, it is pretty much the same. We are treated by our GPs at first, but if the medications he prescribes are not managing the pain effectively, then he will refer us to a specialised 'Pain Clinic'. These clinics are usually attached to a hospital and also have many different practitioners - from the Consultant downwards. In my case, it was recommended that I attend their Pain Management Programme (for 6 weeks) when I was first referred - I found this very helpful in understanding the mechanics of my spine and how to try and deal with pain etc. The consultant and his team have far more expertise/knowledge about pain meds than my local doctor.

    So thank you for explaining it all to me. I can see it now from both sides (patient/doctor) and, on the whole, it seems most people are satisfied with the arrangement.
    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
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