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An_250887 posted:
Will post anonymosly, but many will know it is me. Paranoid about who reads these things.

Have had a heck of a time getting my meds each month. Go to my PM doc and then head off to the pharmacy. Am on 2 opiates (1 main and 1 for breakthrough) and neurontin. Get switched back and forth between 2 main opiates when my body starts to metabolize it faster and it is no longer effective.

You would think this is pretty simple. My doc is frustrated because he would like to try other drugs he feels may help my pain, but due to the expense, he KNOWS they will be denied.

I just had a medication review between my doc and the insurance company. They were in FULL agreement. Didn't matter.

Spent the week making MULTIPLE phone calls to my doc, attorney, medical 3rd party and my former employer. Was told I would have and approval or denial in 24-48 hours. Four days later...

Claimed it was my doctors fault. Claimed the insurance company does not have the authority to deny meds, but can deny based on not meeting certain criteria...HUH? Said I would never be denied a med based on price. Told them I would be sure to TELL MY DOC!

We went round and round about the need for my meds to be changed yearly. Was told I had kept them on the phone for 18 minutes. Seemed like this person couldn't understand me, so I asked if they had a medical background. Said I was not trying to be rude, but was trying to find the best way to explain the situation. They got pretty LOUD and said their background was NON OF MY BUSINESS and I DIDN'T NEED TO KNOW ANYTHING ABOUT THEM.

Anyone else going through this every month or two?
aprilrose9 responded:
Sorry mispelled anonymously!
aprilrose9 replied to aprilrose9's response:
Do you guys believe how dumb I am? Can't even remember to tick the right box.

Constantly frustrated with myself. I used to have a brain which functioned and now I have about zero concentration. Think 20% of the problem is the pain meds/neurontin and 80% is due to the wretched pain.
davedsel2 replied to aprilrose9's response:
Hello, Aprilrose.

I am so sorry you are going through this ordeal. I fully understand about pain affecting concentration and mental functions. Mine are just not what they used to be, either.

I had one thought that might be crazy. Can you sign up for a pharmacy's discount program (I know Walgreens, RightAid and CVS all have such programs) and get your prescriptions for these meds that way? No hassling with insurance companies, just getting the script from the doctor. Just a suggestion from my weakened brain.

I do pray you can get all this resolved soon.
Please click on my username or avatar picture to read my story.


aprilrose9 replied to davedsel2's response:
Dear Dave, It is a good suggestion and one I did not think about. Will ask my attorney if this is a route which may work out.

Since everything is through self-insured workers compensation, I am at a loss how some of this works. No matter how many questions I ask, I seem to get a variety of answers depending on who is giving the info. This may be part of my frustration.

My husband is a master at getting to the bottom of things, but this is a battle I must fight on my own. Yesterday I tried to get a price difference on an item I purchased and ran into a brick wal. He could not believe how quickly I caved and was ready to return the item and not repurchase. In one phone call, all the while being polite, but firm, he got me a 150.00 credited to my original form of payment.

He thinks I too am sometimes trying to get things done, like when I have had home builders make a mistake right, but in this workers comp junk I feel constantly frustrated.
When I was working, I had a strong reputation of being an advacate for my patients. I find it far harder to fight this system as a patient, than I ever found fighting an acute care hospital setting for my patients.

In my opinion corporations have far too many "rights" v the injured worker. I find patients going without appproprite care, frankly shameful.

I have already spent over 10 thousand dollars on medication and other things I have needed over the years. I may have to go back to opening up my handbag.

Also, my doc has mentioned a pain pump. I know this may better control my pain, be better for my liver and perhaps, easier to get the medication paid for...but, who knows?

Thank you for the good advice.

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