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Drug Utilization Reviews from Insurances - More harm than Good!
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J999 posted:
Hello All,

I recently had some dental issues which required some prescriptions for pain meds. I recently found out that my insurance company sends quarterly reports of Prescriptions issued to all providers who prescribed the meds. They indicated to me that they like to do this to keep the practitioners on the same page and it was for patient safety. Anyone else have a problem with this? The reports are so vague they don't explain to the prescribers the reasons for the prescriptions. Therefore it just makes you look like a doctor shopper and then you lose all your providers when they get the reports.

For example, if you are going to a pain clinic, they are not going to prescribe medication for oral surgeries or other surgeries for that matter. My dentist recently refused to ever prescribe me a pain med because she got this report that showed I get pain meds from a pain clinic. As I said, the report is vague and doesn't explain the whole picture. All these reports do is arouse suspicion and make your providers not trust you.

Has anyone else had this problem? I think the insurance company needs to revamp these reports so that the providers can see what EXACTLY is going on. Even if you visit an urgent care just once, they will recieve a report of all the prescriptions you have recieved in the past 3 months. Then they make notes in their computer disallowing you to recieve any prescriptions for pain meds or other controlled substances. The pain clinic is not going to help you when you go to an ER after an accident. The pain clinic even told me (because I am under contract) that you can recieve RX's for pain meds outside our clinic for Surgeries, Dental problems, or colds that can be managed by your primary care. The pain clinic really doesn't care but all your outside providers get these unclear reports and then kick you to the curb. All the reports show is what was prescribed, the quantity, the pharmacy it was filled at and the doctor who prescribed it. I really don't think it is fair for insurance companies to do this without being more clear. It almost makes patients want to fill their prescriptions without insurance.

Please let me know if this makes sense to anyone or if you have had a similar experience.
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annette030 responded:
I don't really care if they do this or not. I recently had surgery and I am on pain management with opioids for chronic pain. I asked my pcp who writes my RX every month to please speak to the surgeon and they could decide who managed what.

The surgeon asked me to see my PM specialist (I have seen him once before, for a consultation) prior to surgery and get his opinion about my meds after surgery.

I had the surgery, my surgeon was more generous than the PM specialist might have been, but I have followed his suggestions since I got home with her permission. The surgeon will control my pain for two weeks after surgery, then my pcp will continue to manage it. I see the surgeon tomorrow for my first weekly visit post op.

I feel if I am up front about everything before surgery, or dental work, or whatever, and the process is out in the open, everything will be fine.

Some of the problems you are having may be due to the insurance company you use. Some states also keep a master list of all the controlled substances one takes so that it can be reviewed. This is not an insurance thing in this case, it is a legal tool.

If I have any problems, I will let you know.

Take care, Annette
 
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bren_bren replied to annette030's response:
Hi Annette,
how are things going now with recovery?
I didn't know what kind of surgery you had, may I ask?
I haven't been online much - especially on this site, but I was happy to check in and see you here.
Take care, B
 
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annette030 replied to bren_bren's response:
Hi, Bren

I had a medically necessary breast reduction. I was carrying alot of weight in the front, and my doctor thought that some of my back pain might improve if I had the "girls" reduced in size. I had it done on 1/19/11, not quite two weeks ago. After one small goof up on the part of the anesthesiologist, everything went fine. I had a great surgeon, and great nurses. I was discharged home the next day. I had the drains removed last Tuesday. I had all these questions ready to ask the doctor, then I realized it has not even been two weeks yet since she did the surgery. I may be rushing things a bit, lol. But I feel great except it hurts of course. They have been generous with the meds so far so my pain is well managed.

Life is good for my family, I hope it is also good for you.

Hugs, Annette


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