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    No insurance, back problems and medication
    jmorr posted:
    Hi all!
    I am new to this community as I usually post on the back pain community or the RA community. If you click on my pic, you can get alittle background. What prompted me to finally go to a DR is that my mother has really severe RA. She has already had 1 knee and 1 rotator cup operated on and she needs the other shoulder and knee operated on. I have found this marvelous free clinic as my work does offer insurance, but it is so crapy that I opted not to take it. With a 1500 deductable and almost 200 a month I thought, geez, i can pay for my own care anyway. Then I had this happen with my back. Which incidently has been going on for 7 years. But with this free clinic, they referred me for another MRI and a followup with an orthepedic dr and this is finally the DX I have.....Lumbar Radiculitis/Lumbar Facet OA/Lumbar DDD/Lumbar Discogenic Pain. He is recommending PT, 4-8 sessions, I go in for a cortisone injection on may 4th right into the back and then gave me prescriptions for tramadol 1-2 3x daily and robaxin -12 3x daily. Anyone ever been on these meds? When I had to go to the ER becuase when the back locks up on me or flares, my right leg does not move and the pain is incredible. So I broke down and went to ER and they gave me prednisone, flexeril and hydrocodone. only enough for 5-10 days as I told them all the appts I have or will have with the ortho dr, and free clinic. Believe me when I say, Drs have access to all records from every hospital that is in there network so they can see whay previous Docs have done for you. And anyway, why would a person lie about being in pain? So I guess my question here is why are drs so afraid to prescribe pain meds? I understand the problems of addicts and pharmacies being robbed for paid meds, but my own dr would not write for narcotics either. Well, tramadol is somewhat of a narcotic isnt it? Oh well. I am just thankful to be getting treatment. And if none of this works, the othro dr is willing to keep treating me until we find what works for me. And this with no insurance. Anyone out there with no insurance, pursue all avenues that you have. Free clinics, medicaid, payment plans, etc..All are willing to work with you. Its a shame that people have to live in pain, and not be considered an addict becuase you ask for medication that works. I just let the dr prescribe what he thought best, and like I said, if it works, great, if not, we can go from there....Hope all have a good day and I am sorry to hear about all the horror stories and problems getting the help you need..
    Kelly_30 responded:
    Hi Jmorr,

    Welcome to the community!! You have found a great place for support and advice! I have been here for about a month.

    I was on Tramadol for 6 years. Two 50 mg tabs every 4 hours for pain. It is a synthetic opioid. It helped with my pain a lot for about 3 years and then the pain relief started to die. A month ago, I was taken off of it for good. I am now on vicodin/percocet for breakthrough pain and morphine ER for baseline pain. It took 6 years of dog and pony shows with the doctor before I was finally given medication that worked. And, unfortunately what works for my pain are opioids.

    Doctors don't precribe easily because the DEA breathes down their neck. Each opioid prescription they precribe can be subject to audit or investigation by the DEA and can ultimately cause them to lose their license. So, they want both a long relationship with the patient and medical records to back up the diagnoses. It sounds like you definitely have the medical records. How long have you been seeing your doctor? Some physicians are scared to prescribed at all. If you have a long history with your current physician and if the tramadol isn't working well for your pain explain this to your MD. Tramadol is usually prescribed before vicodin or percocet so if you pain is not well controlled, these may be the next options. If no other options are offer to you, they may never will (with your current MD) and you may need to switch doctors to get the care that need and deserve.

    Living one day at a time.
    jmorr replied to Kelly_30's response:
    Hi Kelly

    Thanks for your response. I was just barely referred to the ortho doc and my first appt was on the 26th of this month. And he wants me to try the injection and PT sessions before anything else. Right now, I am going to do what he wants me to do as he has been very specific about how he wants to handle my treatment. And since I have no insurance and he is willing to work on a voucher referral meaning the free clinic or whoever picks up the tab, I just paid a 20 dollar copay and the MRI only cost me 50. So I am not rocking the boat at this time. As if this DR agrees to keep treating me after all, then I am grateful..So, hopefully, this is a start. I appreciate your response and I will keep this community posted as to my progress....Have a great day!
    _swank_ replied to jmorr's response:
    Jmorr, I really can't feel sorry for your lack of insurance. You have access to it and you're about to learn how quickly medical bills can add up. The $200 monthly cost and $1500 deductible is really not that bad compared to other plans. You say you can pay for your own care but instead you're going to a free clinic and "whoever picks up the tab". Who do you think is paying for that? High deductible plans should be used along with a health savings account that you can use for out-of-pocket expenses. You would have saved yourself and the taxpayers a lot of money if you had gotten the insurance from your company. You never know when you're going to get sick or injured and will need it.
    An_223777 replied to _swank_'s response:
    I believe that jmorr posted that he/she has had this "back problem" for seven years.

    I did not think that a free clinic would treat someone with a job that offers insurance. I agree that $200 per month with a $1500 deductible is very reasonable.

    I cannot understand why someone who has access to this would opt to seek care at the tax payer's burden: orthopedic appts, MRIs, PT, ER visits, epidural steroid injections. I wonder who pays for the prescriptions.

    My prior knowledge of "free clinics" is that they are designed for the indigent, unemployed, NOT for those with jobs and insurance plans available.

    It sounds as if she has had back pain for seven years and opted out of insurance because she wants the medical care for free.

    My guess is that the doctor prescribed Tramadol rather than a stronger narcotic because, after assessing her pain and diagnoses, the MD does not think she requires anything stronger.

    The MD may or may not prescribe something else depending upon the vague ER reference. If jmorr had already been prescribed the tramadol then went to the ER and got hydrocodone, the potential prescribing MD may view that as MD shopping or drug seeking- having a prescription for pain med from one MD and going to the ER to get a stronger med.

    Don't they check a person's income before giving free medical care and vouchers (whatever they are).

    What would happen if everyone decided to opt out of available insurance and go to free clinics?

    I find jmorr's discussion disturbing.
    annette030 replied to An_223777's response:
    I worked in a volunteer position as an RN twice a week for nine years at a free clinic. We offered care to anyone without insurance, we did not check financial records or ask if insurance was available where they worked. When I started working there 11 years ago, about 85% of our patients were unemployed, when I stopped a couple of years ago, it was about 85% employed, but didn't have insurance. Folks who are unemployed for awhile might get on medicaid in our state if they are legal residents. Most employers in our community do not offer affordable health insurance to all their workers, they say it is too expensive.

    $200 a month with a $1500 deductible may sound good to you, but if you are making minimum wage and supporting more than just yourself, that is very difficult to do. Lots of adults opt to cover their kids first when insurance is available. If you have SSDI or no income at all, it becomes impossible. We had to show we had paid out our deductible before our insurance kicked in for their share. If I had a spare $1500 to pay for MRIs, surgery, etc. I would be very lucky. Thank God for credit cards, and payment plans.

    When I started working as a nurse, I had a $50/year deductible, and never even used that up for many years. I was healthy and used Planned Parenthood for my yearly exams. When my husband retired last year, his health insurance had a $3,000 apiece deductible and horrendous premiums that we paid out of his check, over $400 a month. Now we are on Medicare works fine for us.

    My experience with specialists and other diagnostic workups done for folks using free clinics is that the specialists and radiology places offer pro bono or free appts. It is not paid for by taxes, but by donations from folks willing to give up some free time. The person who accepts this care is free to do what he wishes, I would hope that he would pay it forward by helping someone else. One free clinic in my community was in the news last year because they traded free medical care for volunteer hours by the patients.

    It would be nice if we all could afford insurance, but we can't. I would ask what do insurance companies really do to earn their keep and make money for their shareholders? They are middle men who provide no product or tangible service at all, in my opinion. I think we should get rid of all insurance companies myself. Billing should be clear in who is paying for what and how much. I just had surgery and it is not clear at all. Hospitals and insurance companies have secret contracts for a specific kind of surgery, no one will tell the patient anything, and I am an educated woman.

    Just my opinion, I believe in single payer, universal health care.

    Take care, Annette
    annette030 replied to jmorr's response:
    I wish you the best of luck. Usually in free clinic settings, specialists volunteer their time, a certain number of hours per month. So don't just be grateful, volunteer some of your time somewhere and pay it forward. We can all do something.

    Starting treatment with tramadol is appropriate, let the doctor know if it isn't working and be open to trying whatever he suggests. As you try different things the two of you will learn to trust each other, and he may offer you stronger meds. It sounds like he is doing the right things so far.

    Take care, Annette
    annette030 replied to Kelly_30's response:
    Hi, Kelly

    I have worked in the health care area for most of my life and the DEA never went after anyone I ever met. As long as a doctor does due diligence and documents his care properly, the DEA is not going to bother him. I went to the DEA's website and read about their enforcement and a very small percentage of doctors are ever investigated, let alone prosecuted.

    I also investigated the other side of the coin, by reading all about a doctor who was investigated, and how he ran his "cash only" office, he deserved to get whatever was coming to him. Just him, not every doctor.

    Some doctors don't want to deal with drug abusers constantly making appts. and hassling the doctors for drugs, so they say on the phone that they don't prescribe opiates or treat chronic pain. I don't believe it has much to do with the DEA. I have dealt with law enforcement in the ERs I have worked in and they always knew who was a "soft touch" for opiates and where to find him. These are the doctors who trust the patients to tell them the truth about their pain, and then prescribe accordingly. It can go either way, depending on whether the patient is telling the truth or not.

    Rather than demonize anyone, I try to be a good patient, keep my appts., fill my RXS, be honest with my doctors, etc. If I have a good relationship with my doctors, it is all good for all of us. I have had great doctors over the years. I can only think of one ER doc that might have been a bit testy when I went in for a migraine out of town. ALL my other doctors have managed my pain well, and not ever treated me like a drug addict.

    It is always good to hear your opinion on things.

    Take care, Annette
    _swank_ replied to annette030's response:

    jmorr specifically stated that s/he could pay for his/her own health care. This leads me to believe that she can afford the insurance premium but chooses not to. Instead, she is more than happy to have someone else foot the bill. This is the sort of thing that irritates me no end. People have no problem paying auto and home insurance but when it comes to their own health they don't want to pay for it.

    In the area where I live there is a segment of the population that has insurance. Some are illegal and some are not. But they are working. However, they have decided they don't want to pay the $25 copay to see a doctor so they lie and say they don't have insurance. Then they go ahead and apply, and are granted, Medicaid. They go to specialists or whoever they want and don't pay a dime. This is what makes insurance so expensive for the rest of us. I lost my job months ago and my insurance costs more than my mortgage. I can't afford it but I can't afford not to have it so I pay.

    As long as people are under the assumption that their health care is someone else's responsibility then we will never fix our health care problem.
    Kelly_30 replied to annette030's response:
    Hi Annette,

    I agree with your post and I enjoy reading your posts as well.

    You are right that the DEA usually doesn't come after the doctors. But there are some doctors out there that are afraid of ghosts that aren't really there. They are fearful of the DEA when all they should fear is fear itself.

    Those "cash only" pain management clinics are bad news and are making it harder for us with legititmate pain. Pain is highly subjective. A lot of trust is involved between patient and doctor. This I agree with.

    There are some folks that go to the "easy" doctors not because they are drug seekers but genuinely need help for their pain and the MDs they have went to previously won't listen to them. It is so hard to determine the drug seekers from legimate patients. If the patient's records don't show frequent visits to ER/Doctor Shopping/Filling at multiple pharmacies and/or the patient doesn't come in demanding certain medications by name, look dingy and run down, have track marks on their arms or other places, and damaged skin, it usually a subjective determination on whether or not the patient is a drug seeker.

    Living one day at a time.
    ctbeth replied to _swank_'s response:
    I'm on your side of this syllogism. Jmorr states,

    " I have found this marvelous free clinic as my work does offer insurance, but it is so crapy(sic) that I opted not to take it. With a 1500 deductable (sic) and almost 200 a month I thought, geez (sic) , i (sic) can pay for my own care anyway."- NOT, "I can not pay for insurance and go to a free clinic and have someone else pay.

    Stated also that this back pain began seven yr ago.
    All corporations have to offer insurance plan changes, adds, drops every year (open enrollment) . If he/she wanted to be a self-pay initially, once she suspected medical issues that would mean MD visits, radio tests, specialists, that would indicate it is time to do the responsible thing and enroll. To not buy the available insurance and opt for free care is, in my opinion, selfish and wrong.

    The patients in my area who go to the free clinic have to wait months for appointments. There are no volunteers from the community, but paid residents from the two local medical schools.

    There are no volunteers among the staff, but paid nurses (mostly LPNs) and support staff. The recipients of the "free" care do not volunteer. It is not a co-op, it is care paid for through the taxpayers of the state of Connecticut. One must qualify for medicaid (not medicare) or be homeless.

    A person with a job who refuses to pay for an available insurance plan because she says that she can afford her medical care, should be denied treatment at free clinics.

    If this was available and morally just, why don't we all get our doctor appts, surgeries, pain management, physical therapy, prescriptions, MRIs, etc at no cost to us?

    How about the charges I incurred for ambulance, Life Star Helicopter service, orthopedic, neurosurgery, and the over-two million dollars my care has cost thus far? I have an 80/ 20 policy.

    Twenty percent of two million dollars left me in quite a lot of debt. Should I have been able to get this for FREE if I decided that I hadn't wanted to pay my insurance premium?

    At the end of the day, each of us has to live with ourselves and the moral decisions we make. Some feel entitled and make justification; most of us know when what we are doing is wrong.

    A co-op would make for a brilliant clinic: care recipients, persons court-ordered to community service, volunteers, but the clinics in Connecticut do not function this way.

    That our system has flaws does not justify abusing it.
    annette030 replied to _swank_'s response:
    What I understood jmorr to say was that the insurance was crappy and he/she opted not to take it. I don't know from that post if he could afford it or not.

    I am a nurse, and I have always believed that in the USA, decent, basic health care should be a right for all of our citizens, just like a K-12 education is. I believe that if we had universal health care and taxed appropriately to pay for it, then we could all be covered. I would not mind paying higher taxes for that. Every other first world country manages to do that much. The USA is not even in the running when it comes to markers like maternal/child death rates, age expectations, etc. for good quality health care. We don't cover hypertension, or diabetes like we should because many people never see a doctor to get basic stuff done, so instead those people have heart attacks and strokes and we pay the big bucks for hospital care. It is humiliating for most people to come to a free clinic, they wait for hours to see a doctor, the waiting room is hot, and the chairs are hard. Few people in my experience are willing to do that to save twenty bucks on a copay.

    If Medicaid/Medicare were expanded to cover everyone, and taxes were collected from the healthy as well as the sick like they should be to pay for it and you eliminate the middle man, maybe it would be cheaper, I don't know. I am not an economist, just a nurse.

    There are lots of reasons why health insurance is so expensive, my problem is not the deadbeat patients, but the insurance companies themselves who want to make more $$ to pass it along to their shareholders. No one should be making $$ off of someones illness except the doctor/hospital/? who cares for them.

    Regular doctors, nurses, and specialists are free to volunteer their time and facilities however they wish. In all the nine years I worked at the free clinic volunteering my time, I could probably count on one hand the number of freeloaders that showed up there. All the doctors, medical students, interpreters, and nurses (over 250 per year) who volunteered their time were happy to do so, and were not coerced in any way. I don't think anyone has the right to force you to donate your time, but no one has the right to tell me not to either.

    When you have the choices of paying for your own insurance, OR the roof over your head, OR food on the table for your kids, I feel the insurance would be the first to go. It would for me, although we managed to cover insurance until we were both eligible for Medicare. In this country, no one should have to even make that choice.

    Just my opinion.

    Take care, Annette
    annette030 replied to Kelly_30's response:
    Trust me, I have seen folks who were well kept, had makeup on, and nice clothes and just wanted drugs to get high, and came to the ER to get them.

    There really is no absolutely sure way of telling who is who. Even street living, run down, dingy, drug addicts sometimes have health problems that require an opiate. It would be nice if there was a monitor or a blood test that confirmed the diagnosis of pain.

    It is just sad that doctors even have to use the boogey man (DEA) excuse with patients to avoid the question of using opiates at all. My personal experience is that they just do not want to deal with drug abusers, and the reputation of being a doctor who treats pain with opiates gets around quickly on the street. One ER I worked in had that reputation, because the doctors took the patient's word for it if they had pain (unless they were just too obvious for words). We opted to err on the side of treating a person with pain rather than sending them away.

    It is very subjective, like you said.

    I also enjoy real discussions here, we don't have to always agree on everything, we all have our own set of experiences, but we can talk about things civilly.

    Take care, Annette
    annette030 replied to ctbeth's response:
    Like I said, we kept up on our insurance until we qualified for medicare. I would not abuse the system, but I will fight and vote to change it. Obama's plan sucks in my opinion, because he is willing to push people onto insurance companies.

    Have you actually paid the 20% of 2 million dollars? Do they charge you interest? That is crazy... Our insurance had a yearly limit, so they would not have paid for all of that anyway. It would have been on us to pay for all of it after 1 million dollars, the 20% would only apply for the first million per year. Health care costs so much nowadays, if you are in a serious accident you can eat up that first million fast. That is one thing Obama got right, no more annual limits on insurance.

    My parents did not have medical insurance when my dad got lung cancer and died 9 months later. My mom paid each medical person she owed $5-10 a month, when she paid one person off she added that amount to the next person in line. It took her nearly until she was retired to pay off all that debt. Dad died when both of them were 45 years old. She retired at 65. She did what she thought was right.

    Nowadays, hospitals and doctors turn their patients over to collection agencies. I was told by a hospital 2 years ago that if I could pay off our copays/coinsurance in two years on a payment plan and never missed a payment they would not turn us over to collections for my husband's hip replacement. We paid about $5,000 ourselves. Cash and credit cards. It was the only way he could keep working so we would have health insurance.

    Most communities have a variety of free/low cost clinics available. We have a county primary care clinic that sounds like it is run similarly to the one you describe. Paid staff. There is more than one free clinic (like the one where I volunteered) in the Portland, OR area, but they don't advertise. It took me over a year to find the one I did work at, there happened to be an article in the newspaper about them, so I called.

    We had patients on an advisory board that said we should charge something so people would not feel so terrible about coming, so we charged a $10 a visit voluntary donation, but made it clear it was not necessary to see a doctor if they did not have it. People who could, paid more, and some did not pay at all. Some came back when they were in a better place and gave us $$ or time as a volunteer.

    I am not yet of a mind that most people are out to get everything for free. People do dumb things sometimes, but it is often because they don't think it all through. I think skipping insurance until you think you might need it and then signing up for it is wrong, I think that is abusing the system. Insurance does not pay full price either, the companies bargain the price way down and contract with doctors and hospitals to pay those lower rates. Then the hospitals charge more to those who do not have insurance and are willing, like my mom was, to pay full price. We all pay in the end, either through raised hospital rates, or raised insurance fees. I would rather pay through taxes.

    Everyone feels differently about this topic. I think that is okay, perhaps we will all learn something from this discussion.

    Take care, Annette
    ctbeth replied to annette030's response:
    The answer is yes and no.
    I have paid over one hundred thousand. Much, at this point, through court order, is under letters of protection through my attorney's filings.

    I'm pretty sure you are familiar with what this means, but for those who do not, it is a court order that states that when my case is settled, the remainder of the money I owe will be paid out of an escrow acct. set up for me by my attorneys.

    After all the liabilities are satisfied, including 20% to the law firm, I get what is left. This has eased the initial burden of the outrageous debt with which I was faced.

    Until this order went into effect, there was no one that was willing to take a "good faith" payment of a hundred a month or so. I was expected to pay significant amounts per month, and interest accrued meanwhile.

    Having the legal arrangements to protect my care-givers, also protects me from bill collectors and having to part with much of my income and assets.

    One surgeon (ortho) placed a lien on my home before the court-ordered letters of protection were in place. The case will be settled before I sell my home, and interest does not accrue after the lien is placed, so it is actually beneficial to me. Since the debt is all medical bills, they cannot force the lien and foreclose on me. I am fortunate to have fine legal representation.

    I can only imagine how sweet my life would be if I had been able to go to free clinics and get any of this at the taxpayer's expense.

    I had no MDs or hospitals who offered pro-bono care. I applied to a "free bed fund" at one of the hospitals where I spent a few days in ICU, but I was denied as I own my home and had some investment money at that time. It is all gone now due to medical co-payments. That I still own my home mortgage free excludes me from any charities.

    It bothers me when I let is because, by all measures, I had done things the "right way": got a fine education and job I loved that paid me well, raised my children properly, saved and invested for my children's college educations, worked at the same hospital long enough to earn a pension, invested in a Roth IRA for my retirement, paid off my mortgage early by working overtime and, for a few years working a second part-time job. It is all gone now, except my home.

    As I perceive it now, there is no use in any other frame of mind than to accept my life and be ever grateful for the blessings of my family and friends.

    Still, I worked very hard and went without a lot to save and invest for mine and my children's futures. My hope is that when my personal injury case is settled I'll be able to live a little more the way that we had before been accustomed.

    I'd also love to sell my house and buy a smaller home, like a cottage, on the beach. I know that this dream will be fulfilled someday...

    I hope your weather on the upper-left is as nice as on the upper-right.


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