Re: OT- Rant

[Guest guest]

I have no answers for you, but advice to keep calling, and writing, demand

action. Your doctor should be concerned that you get your medication. Are you

going to go through withdrawal if you don't get your meds? I would say yes.

Demand that your doctor hospitalize you before that happens or call Humana and

tell them they are putting his patient in danger by not filling the prescription

promptly.

Get on their case about it. There should be a department at the insurance

company that deals with customer dissatisfaction especially when they are

causing the problem.

Don't stop till you get action.

Jennette

> M. wrote:

> I cannot keep living like this. My 22nd birthday is supposed to be October 21,

but I don't think I can make it. I'm really scared and I have no one else to

talk to.

[Guest guest]

Steve,

I feel for you. I can understand how you feel. I went through a big deal with

medicare getting them to cover my insulin pump supplies. They finely covered

the first claim from a year ago! I had to keep asking my doctor to resubmit

copies of my records.

I live in Pa also. I understand that there is a state insurance monitoring

board. If you have a complaint about an insurance company you can call

burg. My other suggestion is to call your local representative and see if

they can help. Also call the local or state disability group.

Insurance companies want to save money on patients. They will jerk you around

to avoid spending money.

File appeals with your insurance company for denials. Keep at it. You may have

a better chance if they know you are serious.

Start raising hell. Insurance companies don't want negative public image. If

they are not fulfilling their contract start spreading the word. Put your

concern in writing so you have a copy.

I wish I could tell you something more helpful. I know how stressful it is.

When you have chronic health problems the last thing you need is problems

getting the medications and aids you need.

If I find out any more information that would help for our state, I will post

it.

Huge gentle hugs, Tami

> M. wrote:

> Between all of this crap and no one being willing to manage a pump for me (I'm

too much of a liability because I'm " too sick " ), I don't think I can keep going.

[Guest guest]

> Jennette wrote:

> Get on their case about it. There should be a department at the insurance

company that deals with customer dissatisfaction especially when they are

causing the problem.

>> M. wrote:

>> I cannot keep living like this. My 22nd birthday is supposed to be October

21, but I don't think I can make it. I'm really scared and I have no one else to

talk to.

,

I hate beating a dead horse to death but taking a pain diary that documents you

pain levels, triggers, medications and their response to keep you pain down

might be beneficial. You can find one at American Pain Foundation under

publications and click on the Target your Pain Notebook, it has a template you

can print out that covers this, it can be kept in a three ring notebook, and

comments and physical/functional activity can be documented.

I know when I worked for the Cancer Clinic, we rotated the patients pain

medications because of tolerance or either increase it. I would have the Doctor

put this in my medical records for documentation. This way it covers the

objections a Doctor would have:

1-Verifies you pain in real, the level of pain you endure, if you medication is

appropriate, if different or other medication should be used or pain be

titieres.

2. Verifies the functional level you are at and if the medication is allowing

you increase this level or not.

3-Protects you Doctor if audited as there is written documentation of you pain

levels and that the increased or different medication was verified and

appropriate. *This is the MAIN reason Doctors do not prescribe pain medications

at levels they think they would be audited and get in trouble with the DEA.

Justification is important and that is the reason people have their urine or

testing to see if the appropriate amount of medication is in your system and if

you are taking the medications given and no others you are not given or

prescribed. You need to read your pain contract to see the parameters your

Doctor imposes on his patient.

4-It provides documentation for you and others to write referrals for other

services for you : Physical Therapy, Counselor, Mobility Equipment, and other

services or verification the Doctor might need to sign for and he has the

justification in the medical record and this is what insurance and others will

ask for and it is provided in one place.

The dairy/journal keeps a record of information that you might need as a patient

when asking for other services or assistance.

Calling, writing, and demanding to the same person who did not respond will only

make them irritated. Presenting the information in a different format helps and

if he does not

address these in writing, then you have your justification to state the Doctor

is not provided appropriate or does not meet " standard of care " . The insurance

companies, medical representatives, administrative compare your treatment to

their " Best Practices or Standard of Care " .

Contacting your Insurance Company and asking for a case manager will get you

assistance quicker than the main number.

Washington State and other areas adhere to the Best Practices that are

recommended and used by Washington State and the Guidelines the Agency Medical

Directors Group developed and this program has been presented at pain management

Doctors Seminars, Regular Doctors Seminar, and has been presented to the DEA and

Federal Government to Adopt.

These are guidelines (not the last word except where a state adopts them) and

they do not compare with the Medications Allowable Dose. Whereas, Morphine

Guidelines is that it should not exceed

Immediate-release: 10mg q 4 hours,Sustained-release: 15mg q 12 hours and the

medical insert on the medication states up to 1600 mg/24 hours.

Now this is a big difference and this booklet has the chart for all opoids and

how a Doctor should monitor a patient on these " opoids " to prevent overdosing or

checking them to make sure they are not addicts.

These Guidelines, although written for non cancer patients, are being placed on

cancer pain patients also. They do not address that a person without cancer may

hurt as much as or more than a person with cancer.

I encourage each one of you to read this booklet as Pain Specialists and other

Doctors are taking these " Best Practices " as law when it is not and even states

it is " what it should be to prevent all patients not to overdose " but a patient

will over dose or if addict will just take more and go to another doctor to get

" two prescriptions " and take them both.

These " best practices " punish legitimate pain patients from getting the

appropriate relief they need as Doctors fear being audited or shut down.

Here is their information:

In 2009, the AMDG surveyed medical providers in Washington State to assess the

acceptability and usefulness of the guideline and to identify ways to improve it

(available at http://www.agencymeddirectors.wa.gov/Files/AG ReportFinal.pdf ).

Results of the survey support the continued use of this guideline with the

addition of clinical tools and improved information for accessing specialty

consultations.

Recent studies indicate a dramatic increase in accidental deaths associated with

the use of prescription opioids and an increasing average daily morphine

equivalent dose (MED) of the most potent opioids since 19991-3. Between

1999–2006, people aged 35–54 years had higher poisoning death rates

involving opioid analgesics than those in any other age group4.

In response to the increasing morbidity and mortality associated with the

increasing use of opioids, the Centers for Disease Control and Prevention5 has

1 The AMDG consists of the medical directors from these WA State Agencies:

Corrections, Social and Health Services (Medicaid), Labor and Industries, and

the Health Care Authority

1 The AMDG consists of the medical directors from these WA State Agencies:

Corrections, Social and Health Services (Medicaid), Labor and Industries, and

the Health Care Authority

released several recommendations for how health care providers can help. The

recommendations include:

⣠Use opioid medications for acute or chronic pain only after determining that

alternative therapies do not deliver adequate pain relief. The lowest effective

dose of opioids should be used.

⣠In addition to behavioral screening and use of patient agreements, consider

random, periodic, targeted urine testing for opioids and other drugs for any

patient less than 65 years old with noncancer pain who has been treated with

opioids for more than six weeks.

⣠If a patient’s dosage has increased to 120 mg MED per day or more without

substantial improvement in function and pain, seek a consult from a pain

specialist.

⣠Do not prescribe long-acting or controlled- release opioids (e.g.,

OxyContin®, fentanyl patches, and methadone) for acute pain.

The full report can be found at

www.cdc.gov/HomeandRecreationalSafety/ Poisoning/brief.htm .

Data collected in Washington state show:

⣠During 2004–2007, 1,668 WA residents had confirmed unintentional poisoning

deaths due to prescription opioid related overdoses6. Nearly half of these

deaths were in the Medicaid population.

The Guidelines have a chart and show what should be done before prescribing

opoids (completion of over twelve surveys/questionnaires) This discusses daily

limits on opoids :

Figure 1. Morphine Equivalent Dose Calculation

For patients taking more than one opioid, the morphine equivalent doses of the

different opioids must be added together to determine the cumulative dose (see

Table 5 in Appendix A for MEDs of selected medications). For example, if a

patient takes six hydrocodone 5mg / acetaminophen 500mg and two 20mg oxycodone

extended release tablets per day, the cumulative dose may be calculated as

follows:

1) Hydrocodone 5mg x 6 tablets per day = 30mg per day.

2) Using the Equianalgesic Dose table in Appendix A, 30mg Hydrocodone = 30mg

morphine equivalents.

3) Oxycodone 20mg x 2 tablets per day = 40mg per day.

4) Per Equianalgesic Dose table, 20mg oxycodone = 30mg morphine so 40mg

oxycodone = 60mg morphine equivalents.

5) Cumulative dose is 30mg + 60mg = 90mg morphine equivalents per day.

An electronic opioid dose calculator can be downloaded at

www.agencymeddirectors.wa.gov/guidelines.asp

elpful in monitoring your patient’s progress include, but are not limited to:

⣠SF36 Health Survey* www.rand.org/health/surveys_tools/mos/

mos_core_36item.html

⣠Brief Pain Inventory*

Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (CNCP)

⣠www.ohsu.edu/ahec/pain/paininventory.pdf ⣠QuickDash* for musculoskeletal

disorders of the

upper extremities

⣠www.dash.iwh.on.ca/outcome_quick.htm

⣠Quality of Life Scale*

⣠www.uic.edu/orgs/qli/questionnaires/ questionnairehome.htm

⣠Oswestry Disability Index* ⣠www.workcover.com/public/download.aspx?i

d=794 & str=disability index oswestry

⣠Neck Disability Index* ⣠www.workcover.com/public/download.aspx?i

d=792 & str=disability index neck

⣠Short Musculoskeletal Function Assessment* See:

www.ejbjs.org/cgi/reprint/81/9/1245

This booklet did have a great wedsite source to find physicians in an area which

if you need a Doctor in any speciality, it allows you to type in the speciality

and location :

* These instruments have all been independently validated and may be available

at websites other than those listed above.

The University of Washington School of Medicine and its academic medical centers

offer a toll free consultation and referral service available 24 hours per day 7

days per week. This service helps link you with a faculty physician with

expertise in any particular area. To access these services visit, call

, email medcon@... or visit,

http://uwmedicine.washington.edu/Patient- Care/Referrals/Pages/MEDCON.aspx.Click

on the tab, “Make a Referral†and then the tab “Expertise†and enter the

specialty for which you are seeking assistance.

Acute, Chronic, and Intractable Pain patients are categorized and given

medications depending on the category. If you have pain 24/7 you are an

intractable pain patient but because Doctors are not familiar with this

category, I am sure many of us are " labeled " as chronic pain patient. I went to

a legitimate pain specialist for five years that did research in this area and

he was a well-known

and wrote much about Oophobia. This is the " fear of opoid medicine " and the mis

conception that it is not appropriate pain treatment and he gave medication

therapy to overcome or take care of the pain. His patients had to keep a pain

dairy, functional assessment and supportive measures for pain. Supportive

measures such as physical therapy, heat, topical therapy, acupuncture, and other

alternative therapies.

Dr. Forest Tenent, pain patient Doctor and researcher comes through again with

an article of Prescribing Opoids RIght and overcoming Opiophobia

..pain-topics.org/pdf/OvercomingOpiophobia.pdf

Dr Tenent also did a ten and twenty year study on patient who have been opoids

that long.[PDF] from foresttennant.comMD Forest Tennant - foresttennant.com

Dr. Tennents work has in allowed physicians to prescribe and patients to receive

opioids by help enacting an “Intractable Pain Actâ€, “ Pain Patient’s

Bill of Rightsâ€, and issuing written guidelines for opioid treatment.

Consequently, enough severe, non-malignant pain patients have now been treated

with opioids to begin long-term evaluation of this treatment. Reported here is

an evaluation of 24 severe, chronic pain patients who have taken daily high

dosages of opioid drugs for at least 10 consecutive years. These patients remain

in opioid treatment as they have had positive outcomes.

I hope the frenzy to prevent " addicts from getting medications " and " overdoses

" does not prevent " real " pain patients get pain relief.. I am a certified

intractable pain patient, I pee in the cup without complaining, follow my pain

contract, and am really in pain and do not need any one telling me I am not or

taking me off medication within the prescribing guidelines because they are

afraid of me being an addict or overdosing.

When I was sick with a virus and threw up my morphine, I took the partially

disintegrated pills and put them in a zip lock bag and called my Doctor and

asked her if she needed to see them or she trusted me. What addict would do

that ? An addict would be washing the vomit off the pills and taking or shooting

them up. It is time for pain patients to receive appropriate medication for

pain and

referencing the bill of rights of Pain Patients ( California )He r resides and

practices in the State of California, USA that has, in the past 15 years,

allowed physicians to prescribe and patients to receive opioids by enacting an

“Intractable Pain Actâ€, “ Pain Patient’s Bill of Rightsâ€, and issuing

written guidelines for opioid treatment. Consequently, enough severe,

non-malignant pain patients have now been treated with opioids to begin

long-term evaluation of this treatment. Reported here is an evaluation of 24

severe, chronic pain patients who have taken daily high dosages of opioid drugs

for at least 10 consecutive years. These patients remain in opioid treatment as

they have had positive outcomes.

Sorry, I did not mean to write a book but all states are looking to adopt some

of the " best practices " and knowing your states laws and intentions should be

researched by all pain patients.

The American Pain Foundation along with other organizations has been forerunners

in making sure legislature gives Pain Patients choices. If you want to sign a

petition for the Pain Patient Rights Act you can sign the up at

http://www.petitiononline.com/pain/petition-sign.html. Virginia, it seems, is

adopting the Washington's guidelines.

This is something we must prevent and it is happening to patients everywhere

that Doctors are no longer going to prescribe or cut down pain medications.

Check your state out by typing in your state and then Pain Patient Act or Pain

Patient Bill of Rights. California Patient Bill of Rights states if the Doctor

you go to does not want to prescribe you opoids for diagnosed pain, he must

refer you to a Doctor that will. Bennie

The National Pain Care Policy Act can be found at :

http://www.govtrack.us/congress/billtext.xpd?bill=h111-756

[Guest guest]

> Tami wrote:

> I understand that there is a state insurance monitoring board. If you have a

complaint about an insurance company you can call burg. My other

suggestion is to call your local representative and see if they can help. Also

call the local or state disability group.

>> M. wrote:

>> Between all of this crap and no one being willing to manage a pump for me

(I'm too much of a liability because I'm " too sick " ), I don't think I can keep

going.

>

Tami,

Oh how right you are ! The state board of insurance and the state attorney

general are also points of contacts after case manager at insurance company. I

still thinking getting home health out is a good idea as Steve deserves it.

Since has Cancer, he should be able to get Hospice support in there

also. Bennie

[Guest guest]

I just went through what you are going through except I deal with the V.A. and

the government when it comes to my medical care. I wear the fentanyl patch and

my doses are 50 micrograms. I am not sure how much you are on but this wasn't

covering my pain needs and I really thought I might kill myself. I prayed,

begged and pleaded for God to take me from this suffering and hard existence,

but here I am still alive. So I went to the hospital and told them I was in

crisis and they helped out temporarily. Now I see the pain doc tomorrow and we

will see what she says.

Good luck and try to hang in there. I know it's hard but you are loved and

cherished! You can mail me anytime. I'll be here to listen.

> M. wrote:

> I cannot keep living like this. My 22nd birthday is supposed to be October

21, but I don't think I can make it. I'm really scared and I have no one else to

talk to.

[Guest guest]

Thanks, I know I haven't been active on any message boards lately, but I have

been reading everyone's comments to my post (and almost everyone's posts)and

you've really been helping me.

Steve M in PA, age 21