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Out of Network Pain Mgmnt Problems

Hi Everyone

I'm new to the Forum and this is my first post, so, forgive me if I don't,  quite, get everything right.

I've had a terrible time since purchasing my Health Ins for this year. We could , only, afford 1 plan and it all seemed great to begin with. Unbelievably,  there was not a p mgmnt dr within a 100 mile radius who took my insurance, but, here comes the good part, an out of network team was allocated to deal with my case so that I could continue with my current Dr, and they would just continue to bill the new company. ( using same medical codes). Seemed great to me. Not so!!! In Jan ( while my husband was overseas) my intrathecal pain pump ran out of medicine). This happened on a Friday, so , despite a visit to the ER , and getting THAT look!!!!!, I was forced to suffer withdrawal for 31/2 days. BTW, this was sue to a miscalculation by the Dr,  when he titrated the pump. My , actual, appt was 5 days later. My husband would be home, everything would be fine. As expected, he called for me and asked if they would, please, fit me in Monday morning  ( as a matter of urgency) The office mgr , who was hired 2 months previously, was not happy when he became a little harrased.  This was understandable,  but she became irate when he pointed out that it was their mistake in the first place!!! I went down for my , begrudged , appt at 9pm. At this point, I was asked for a , fairly substantial,  sum of money. I said that I only had a small amount as I was expecting hubby home and not expecting this, emergency, appt. There was rather a fuss ( very embarrassing) with other patients hearing everything.  However, the Dr did see me. Moving on from Jan, at my NEXT appt , I was forced to pay this, substantial,  sum before I could see the dr, and have my pump refilled!! The office mgr , clearly,  had taken a dislike to us. From that point on, instead of billing the ins co, as previously arranged , no bills have been submittex, prescriptions have been wrong , late. Pain pump ran out early AGAIN. My nerves are , completely,  shot. Its, definitely,  become a harassment campaign. 

Well,  the final straw cane last week , when I received a registered letter telling me " I could no longer be a patient as it was too difficult to work with my insurance co" 

I went to the Drs office to make my final appt, which I was denied. I'm wondering if anyone knows 1 is it legal to deny a patient an appt when they still have a month from the date on the letter ( as stated)

2/ After chasing for 3 days ( my oral meds had run out 3 days prior, again) the Dr said an e script was being sent

3/ The script was TAPERING my meds ( he's seen fit  to have me on the sane amount of oral medication for 2 years. The TAPER turned out to be " over 4 weeks, from 6 tablets every day, week 1. 5 tabs a day . Week 2 , 4 tabs a day. Week 3, 3 tabs a day, week 4, 2 tabs a day 

4/ An addendum from the office manager. Exact words " it's not our fault if the script doesn't fill. We're not doing any more prior authorizations for you.

So, I'm very sorry if my first post is too long, but I tried to put all of the valid points in. This woman has made life miserable, single handedly turned me into a jelly ( nervous wreck ), who doesn't want to leave the house. I feel like there's nothing I can do. This has all been a vindictive campaign, none of which was necessary. I've been a good patient for 2 years. I've sat the,obligatory,  2 to 3 hours in the waiting room when we've all been triple booked .

I'm a nice person, but I feel helpless and just had to vent!!! Has anyone else experienced ANYTHING like this??

Again, I know this is miles long, but I wanted to include everything . I'm excited to be able to talk to other people  suffering from chronic pain. Also, to give my friends and family  ( but mostly my poor husband) a break from my , endless, complaining about how unfair the world is.

The end.



  • Are you on your husband’s insurance plan? 

    If you’re not working maybe you can go to healthcare dot gov and sign up for a plan with a subsidy. 

    That way you’ll have access to more doctors in general.

    May not be an option. I’m just brainstorming.

  • Callum21CCallum21 Posts: 1
    edited 04/09/2018 - 9:11 PM

    I hadn't really thought of that. Yes, I'm the 2nd on my partners policy. I had to resign from work last May, I really wasn't fit!! We are living , just, above the poverty line, but, also in the midst of completing citizenship applications. We had a huge amount to offset the premium every month, so, our premium was 0 dollars a month, with only $675 deductible each.  My Dr ( another, not this 1) obv!!! Has stated that she'll sign all the forms to state that I'm unfit for work, now and permanently. I believe I would then qualify for Medicaid  ( another minefield , what with Part A, part D , part 2, Part 4 etc) . I fear I'd be lost forever under a pile of paperwork. I would never stay with this Dr. I'm now 7 or more ( lost count in the throws of withdrawal) days without my medicine, which is, really, shocking. I'll look into buying supplementary Health Insurance, just to cover this 1, very important, area. Thank you for the adviceL4_L5. I appreciate it.

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  • Is your husband overseas due to military service?  If so, you should be covered under Tricare.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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