They are starting to scare me.

[curiousforever]

They (my new primary care doc) are referring me to pain management. I've told the doc that there is NOONE here where I live (that takes Tri-care) - except one that ONLY does injections - and I've been there and he says no injections will help me.

So I get the referral today. I try to call the mangled phone number on the paper. No dice.

I call them to get the number. I stay on hold 20 minutes - no dice. They call me back and give me the number. No surprise when the place tells me they don't take Tri-care.

I call them back and tell them - so they are now calling the doc that does injections. After I tell her again that that is all he does - and he doesn't script meds.

So, still waiting.

This is after showing the doc the knot right above the nerve biopsy - and telling him that standing for about 10 minutes causes great pain in my lower back. Telling him I can't hold a book for more than about 8 minutes without having pain in my hand. Telling him that I can't chew gum cause it causes pain in my face. (even food will if it's chewy).

He doesn't want to give me break thru meds cause people have cancer. !?!

I explain about the shopping trip that left me almost unable to move - due to great pain. Then the shopping trip on the fentynal patch and percs that I was only a little tired after - but able to MOVE.

He starts saying I'm going to kill myself cause of the tylenol (the dose is 1 tab every 6 hours). Monday I have to go to the lab for liver tests and junk.

Finally I just ask him if we can continue on this route for now - that the PM is pending, the Balboa thing is pending - and if the liver tests show problems, that I will discontinue the percs and just not be able to do anything. He goes with that.

Then express scripts denys the script of percs as duplicate meds. I ask Mr pharmacist to call them - cause these are break thru meds. He says he can't. He gives me the number - I go to the insurance company next to the pharmacy and beg to use their phone. I end up there for 10 m inutes standing with my back killing me cause she won't give ME the 'code' to override it - and the pharmacy phone is busy.

It takes 35 minutes to get home and the boys were getting out of school in 35 minutes - which I mention to her.

Finally it's all done...I got home 1 minute before one of my boys walked in the door. It took 3 hours between the doc and the pharmacy. Not too bad - I guess I should have left the house earlier.

But it's scaring me the way it's going - with the doc. I mean come on- why don't they listen to me about the PM docs? The referral with the mangled number and no doctor name?

[tenacious]

i can't say that i am surprised, althoughn i am sorry that you have been going through this. it seems that cp patients have to go through hoops to finally get some relief..........and i hope that those hoops end very soon.

i would recommend, though, that you do your own calling around to find out who takes your insurance, and then give that doc name to your pcp.

[BrokenBladder]

Curiousforever I'm so sorry for the agony that you're going through. Truly your doctor should have a list of which doctors take Tri-Care, but that's in a perfect world.
Is it possible that you could get that one PM to write a letter saying that he only does injections and no scripts? Also that in his opinion they don't work on you. If you could get something like that maybe your other doctor would be more willing to help.
Take Care!! ((((HUGS))))

[waggytalk]

man its stuff like this that makes me happy i have a good PCD and pain doctor.

[Mark N]

I am sorry you had to go through this today. Like waggytalk, I am very glad to have my PCP that does my meds.

[Bobbi]

Curious,

I don't know how your Tri-care is administered or whether you have access to H.R. people. But it was the H.R. coordinator through my current company (about to close) that pulled everything together.

I totally empathize with you.

Again, I don't know how your insurance is set up. It's been a royal pain for me to get things worked out.

I can't even begin to broach the topic of breathru medications, since I haven't any. When my medication doesn't work or runs out... after trying to make it stretch to the date of refills, well, I'm just SOL. My insurance has had other ideas it had tried pushing, but those just were not do-able.

Maybe if you could be referred to PT or someone, and that person did an assessment, it might help. (My referring docs. also rely on what the PT reports back to help determine the course to take.) Just a thought.

[lobelsteve]

I would not call the doctors office anymore. Staf acts like they are being harrassed by every phone call. Write a letter to the doctor explaining all of your prior care, your current meds, the inability to get care elsewhere, and your willingness to follow the most rigorous guidelines regarding medication management.

You then will have to explain to this doctor what that means because it is obvious he/she dos not know how to manage chronic pain patients.

1. Opioid agreement (www.legalsideofpain.com) and many other sites have samples.
2. Frequent UDS (see my post in another thread for the PDF monograph on how to do this)
3. Pill counts. It is unreasonable for you to have to go to that office for pill counts, but if he can talk to your pharmacist and arrange for you to go to a convenient pharmacy location, the pharmacist can do a pill count every month at the 2 week interval between appointments and report back to the doctor.
4. You can buy a safe/lockbox, bring in a picture of the safe and a receipt and put that on your chart.

If the new doctor still cannot treat you then you need to change to what a "reasonable" doctor would do. I also understand that the doctor has no obligation to treat outside his/her comfort range. I certainly do not write for BP meds or insulin. You may have to find a pain clinic hours away that can do all of this but only see you every 3 months. I have several patients that live 4 or more hours away coming to my office. The distance to travel sure is a red flag for law enforcement, but we document the heck out of things. SOme of those long distance folks just moved away from ATL and did not want to go through the ordeal of finding new PM. We do the above steps for them and have them see a PCP in their area to get UDS if they wont be in our office for a few months.

[Jyes]

Curious

Since I will most likely be going to TRICARE next year and suspending my BC/BS federal health insurance, your statement about only one PM doctor taking TRICARE caught my eye.

I had been told by a couple of my Doctor's in the past year that they dropped or are going to drop BC/BS! So, I asked it they take TRICARE and the answer was Yes, we have to if we accept Medicare............

So, I just did a quick Google search and that seems to be the case that if a Doctor accept Medicare, they must accept TRICARE, but not the other way around and Hospitals seem to have to accept both or none at all.
Here is an excerpt of that statement:

"A physician is allowed to accept TRICARE, but opt-out of Medicare. The reverse, however, is not the case; if a physician accepts Medicare, he must accept TRICARE. "

"Institutions (hospitals) do not have this option. They must accept or reject both. See http://www.tricare.osd.mil/CFR/C6.PDF for balance billing regulations of Non-Participating (but Authorized) Providers"

I hope TRICARE Doctors are not so limited in my area, since the ones that accept BC/BS is dwindling each year!

Jyes

[Kathi49]

Jyes,

Are you going with TRICARE Prime? I am just curious. When I retired, I took fed BC/BS with me of course (not eligible for Medicare yet). And, until just recently, I was carrying family. Whew! Thank goodness my husband and daughter came off LOL! And my husband, being a fed emp as well, elected BC/BS this past year. Anyway, a few years ago he thought he would want to go with TRICARE Prime. When we went to the local office to discuss all of this, NONE of our primary docs at that time were listed. So, we opted to stick with BC/BS. And, well, I had a real issue with having to ask for referrals. To make a long story short, WE do use TRICARE STANDARD as secondary. Actually, it seems like they cover more. But at times they won't cover or pick up any residual; depending on what it is. But I am not "up" on all the TRICARE info. as my husband is. So, my problem seemed to be the opposite; all my docs take BC/BS. TRICARE is another matter altogether. I often talk with active and retired military and their families; most are friends of ours. And it seems they have a great deal of difficulty locating doctors and/or obtaining referrals. Must be the region ya think?? :) All I can say with absolute certainy is that when my husband read through the TRICARE booklets THOROUGHLY, he was somewhat disgusted.

Oh, and one more question? Before you drop BC/BS have you looked at the others such as Mail Handlers, etc.?

[Jyes]

Kathi,

I have time before I make that decision on Tricare, now I am still not well versed at all on the differnt plans. I, like your husband am somewhat disgusted with what I read about on Tricare ,and on the Dental coverage.

The benefits sure have changed over the years and I will do some serious reading before I "suspend" BC/BS. I have looked at the other plans, YUCK, perhaps once I get old enough for Medicare, which is still quite a few years away, I might consider NALC, which my mother has, but I also know a few who have medical issues like me, that maintain both BC/BS and Tricare until they are eligible for Medicare.

As with Curious only having one PM Doc accepting Tricare, that is worrisome, since if the ruling is that if they accept Medicare they must accept Tricare, does that mean most Doctors in her area do not accept Medicare? Sad, if true.

I believe in my area of Southern New Jersey, all of the Surgeons that I have gone to in the past several years no longer accept BC/BS. Luckily my PM still does and family Doctor, sad state of affairs in that regard...........

Jyes

[Kathi49]

Wow! What is going on in Southern New Jersey? Just kidding. But really, why would the docs drop BC/BS? I, personally, have never had a problem with them but maybe the docs do. It seems here in Indiana and based on my statements they are paying timely.

I do agree with you about the dental. NONE of the fed plans have great dental coverage. We almost opted for Delta Dental but my husband said forget it; he would rather pay out of pocket rather than to pay those premiums. Anyway, we are doing just that; keeping BC/BS as primary and TRICARE as secondary.

Look again at the other plans but I am like you. When I did the comparisons either the premiums were too high or the coverage just wasn't there. So, that is why statistically (based on OPMs reports), BC/BS is selected by fed emps more than any other insurance.

:eek: I guess it all boils down to who accepts what in your area. And, in my own humble opinion, I wouldn't drop BC just yet.

[Kathi49]

Oops, I forgot to add that MAYBE it is a contractual thing with the docs in your area and BC/BS.

[Kira]

I don't have BCBS anymore. I have another HMO through my job. But I had it for years through my dad.

Within BCBS there are a lot of different plans... HMO, PPO, etc. When I had BCBS, we had the HMO, then switched to the PPO. I found that it was hard to find in-network providers for the HMO but much easier to find them for the PPO.

The other thing is that BCBS has changed structure a lot in the past few years (at least around here). They used to be Compcare Blue and now they joined with Anthem and they are called Anthem BCBS, with different a different benefits structure.

Just wondering... do those Tricare/Medicare rules apply to clinics too, or are they talking about hospitals?