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I'm frustrated with....

SavageSavage United StatesPosts: 5,940
..my insurance telling pain management doctor what he has been prescribing for me he can no longer do.

I'm on Medicare with Part D for medications..and have been since 2009 when my body forced me to Disability..at age 53.
If you click my name can view my conditions and spinal issues.

So, my fentanyl patches have been refused. They told doctor he could submit a form stating reason I need it but doc said he would not as it is too time consuming for him. I guess I can't blame him...guess I can't blame anyone ..just frustrating.

Now on OxyContin 2x day and this has happened before where doctor switch me back and forth to not build tolerance.
Doctor then asked me if I was ever on...a med..starts with an " O"....I can't remember..and if ever on morphine or methadone.

I said no to all..and he seemed so matter of fact. But to hear morphine..not too surprising..but methadone...wow...that never entered my mind.
What a fine balancing act to stay stable..never pain free as you all know. And my activities almost nil as I prefer to not stress body where as I need breakthrough pain med. My thought is I may live many years yet and don't want it to be that meds grow ineffective.

Then insurance said they would not cover my med for nausea in pill by mouth form....however they would cover med in vial.
Initially I thought that meant liquid by mouth form and thought no problem. Then I thought vial for injection..but how could that possibly cut costs?
Part of my issues is memory impairment...and aphasia so in trying to keep up withall this information is quite a workout.

Thankfully my pain doc is also neurologist and since seeing him for many years..he so understands me and very helpful. So I trust it to work out. Just felt need to share frustration with you.

Thanks for listening!,
Sue
Spine-Health Moderator
-------------------------------------------------------------------------------------------------------------------------
Please read my medical history at: Medical History

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Comments

  • oldanbrokenooldanbroken Posts: 16
    edited 03/16/2015 - 2:38 AM
    I use medicare part D along with the extra help and I had to change insurance to find one that would cover my meds-Last year I changed twice since the one I started with stopped covering my meds and denied the doctors request.

    I just called medicare and had them find me the right insurance that covered my meds-you can change part D at anytime and don't need to wait a year.

    I am lucky with my part D this year-it doesn't cost me anything a month since the extra help program covers it-I did have to have the Doc submit or Fax a form to them showing them I had tried all other meds and what I am on was the only thing that worked-It was approved-

    Your doc shouldn't even need to be on the phone with them-call your insurance and have them fax the paperwork to your doc-the nurse can fill it out and fax it back to them and within 48h you should have an answer. Or just change your insurance-call medicare and have them fight for you-that what I did and won....

    Good luck
  • The battle goes on right now we have to deal
    with the insurance stuff. I never realized the difference
    there would be in coverage with my employment insurance
    and now Medicare.
    So they fought for you to get what you needed? That
    surprises me I never tried that since I thought if they
    refused to pay that was it. My retired now GP had to send
    in a form to get one med for me and now I have been
    refused Lidoderm patches, so I will need to go that route
    again. Such a headache with everything else.
    Have you noticed the change in care since going on Medicare?
    thanks Sherri
  • I have had to fight with my insurance over ever med...no joke. They won't cover my patches, so I just pay out of pocket...it's like 120 a month. It's so unfair tho. Espically when we have multiple docs over our treatment, telling us what we need to be on....and some yahoo behind a desk comes in and says no. My pharmacist says they have way too much power now and I agree. Docs should over ride anyone on what their patients need....I seriously have anxiety every month going to get my meds cause I know there will be a problem somewhere with the insurance...we shouldn't have to go through all this...
    Spine-Health Moderator 
    DDD
    Ankylosing Spondylitis
    Bulging discs T12-L3
    Annular Tears with Disc Extrusion L4-S1
    Moderate Central Canal Stenosis
    Moderate Foraminal Stenosis
    Enlarged Facet Joints/Ligaments
    Spinal enthesopathy
    L4-L/5 PLIF with cages, rods, screws 2/15 


  • I am pretty lucky-I have an awesome CP doc and he will do anything to help me out-even when I didn't have insurance for about 5 years after I lost my work ins-he took care of me and gave me a cut rate on office visit-I can't afford the medicare ins and so I have the Obamacare ins now and use the medicare part D with extra help to pay to get my meds-at one point I was paying over $400.00 a month just for meds and that took a big chunk out of my budget-It can be a mess and frustrating when you have to jump through hoops or you are made to feel that is what you have to do.

    If you haven't already-check into the Extra Help with the Medicare D-with that it pays my monthly premium and give a cut rate on my meds and so it only cost me $8.00 a month for everything without the doughnut hole . I called medicare and had them do a search for me on my meds to find the best ins that fits my needs and can afford.
  • Hi
    First off I have to commend you on your positive attitude about it all. I would get another
    Doctor if that one won't put in the paperwork to get the med for you.
    One of my PC Doctor's told me that it is a fact that a ton of generics do not work as well as
    the name brand. I have thought of that often about how can they make them so much cheaper.
    I get so upset at the bull we all have to deal with and it is only going to get worse with
    insurance. My insurance agent told me when they start including more past health issues to set
    a persons premium which they are working on we will all be in big trouble. I've read it is in play now
    but it is going to even get worse to afford meds.,, pay insurance premiums, co-pays and unfortunately those who need
    Social Security to live it worries me how some will survive including me.
    I am so surprised at the fact that Medicare will help find insurance but I am going to check into it.
    Boy I was stupid when I worked I thought I would have my excellent insurance until I died, but
    when I got hurt reality sit in.
    I never heard of Extra Help do you have to be a certain income to qualify
    for that? Sorry to those who cannot get the meds they need, to me that is
    right out cruel. I got in such fight over not being able to take any generics in
    the Percocet family other than Endocet. They went on and on about all generics
    being the same but the compounding and color agents can cause different side effects.
    A great Doctor fought and won that one for me but I still get Pharmacies that try
    to battle that one.
    Anyway wish us all good luck with all of it.
    Sherri
  • oldanbrokenooldanbroken Posts: 16
    edited 03/17/2015 - 5:41 AM
    I hear ya....I worked and paid taxes for over 35 years and when I was no longer able to work........well....you are kinda made to feel as if you don't matter and have to fight for everything-I would have never known about the extra help program with medicare D had I not got lucky one day when I called medicare for help understanding something and I got a caring employee that shared that info with me and helped-
    Yes, it is income based-not sure what the cut off is-I get disability SS as my only income and its over 2k a month-Again, I got lucky when I went to get my disability too-I was fast tracked through the system for what ever reason and maxed on the amount-not sure if it was a good lawyer or due to working so long for the state-what ever the reason-I thank God each and every day for allowing things to fall into place for me when it did-I guess living right paid off....lol.....

    I agree, generic medication can be different in some cases, not all-but most, while they are the same meds-different quality of active ingredients can be used as well as some inert or filler/inactive ingredients can be different-or at least that is my understanding/how it was explained to me.

    I am on Oxycontin ER and it doesn't have a generic anymore due to the patent (spelling) and so it is a process every year for me to get it approved-The insurance company faxes the paper work to the PM doc-the PM doc justify the need by evidence of other meds used without success-the ins comp approves and I get my medications.

    I am with Hope here too-it is sad your PM doc won't complete the paper work for the meds you need, however, if you have never been tried on anything else-it might not get approved until you are tried on something they cover and you have documentation that is wasn't effective-I know I had to go through that myself once a long time ago.......it actually ended up being a good thing to change meds for a month for tolerance reason-makes for a long month but it sure helped me in the long run..


    Good luck
  • SavageSavage United StatesPosts: 5,940
    All your comments so helpful!
    I didn't know to call straight to Medicare for help. Last three years I've been working with social worker to help me navigate all this stuff. My speech via phone would be difficult for other person...but I did forget about social worker who may be able to assist with call to Medicare.

    So much money some have to pay out of pocket...just unbelievable....so difficult on anyone's budget.
    Thanks again for assist me think through it!
    Sue
    Spine-Health Moderator
    -------------------------------------------------------------------------------------------------------------------------
    Please read my medical history at: Medical History

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