As we have heard from more readers, an interesting theme has emerged from pain patients who are having either a difficult time finding a doctor who will treat them or are concerned about the type of treatment they are getting.
Steve Ariens, the retired pharmacist who is an articulate advocate for the pain patient, wrote in our comment section some advice for patients who have insurance but are having a hard time finding a doctor to treat them. His advice seems worth sharing for a wider audience.
“For those who have insurance and can’t find a provider to take care of your needs… you need to contact your insurance company… Most likely they have a network of physicians and pharmacies that are within their network… that have agreed to treat pts with the particular insurance. Tell the insurance company… you will probably have to talk to someone higher up than those who just answer the phone… that they need to find a provider to take care of your needs that covered under your policy… If they blow you off… contact state insurance commissioner or www.cms.gov if you are on Medicare/Medicaid/Medicare Advantage… and tell them that your insurance company is compromising your quality of life… by not helping you find someone to treat your medical issues and committing fraud for accepting premiums and not providing covered services.”
Steve’s web page is chock full of advice for patients. Take a look.
Another topic that has come up is the whole issue of treatment. As you know, the National Pain Report is promoting a survey by Terri Lewis, Ph.D that is probing issues around the National Pain Strategy. The response to the survey has been robust and Dr. Lewis is just beginning to assess the results which she will share with us in the future.
She said the influence of insurance companies on pain management choices has been a frequent theme.
“While we would like to believe that the ‘working alliance’ between patients and their providers is a matter of choice, communication, and collaboration, the treatment relationship is impaired by insurance limitations – for drugs that will be reimbursed, copay structures, step wise and fail first policies that force out medications with lesser effectiveness, and so forth. The influence of different types of insurance such as Medicare part D, Medicaid, Workman’s compensation, private insurance, or no insurance at all imposes restrictions on prescribing, dispensing, adherence to treatment regimens, and the availability of patient financial resources to meet copays. ”
Dr. Lewis, who is the daughter and mother of chronic pain patients, thinks the health care system is not geared to appropriately treat chronic pain (and other chronic disease patients. She talked about that in an interview with us.
“Too often, precious professional time that should be spent with patients is spent on the telephone wrangling with prior approvals or making the case for specific medications with known patient history of effectiveness. This is of particular issue when patients migrate from one health care plan to another, when they change providers, or when they move from one location to another. Payor sources lack reciprocal agreements to accept prior patient treatment protocols, a fact which is disruptive to patient care and which forces physicians to play medication roulette. Patients, their providers, and the system effectiveness suffers. An important example of this failure is the very current concern over the drug Tramadol, now associated with hypoglycemia and suicidal ideation. In our survey, patients report that many of their prescribing physicians, fearing scrutiny by DEA over prescribing practices, have supplanted long standing opioid protocols with Tramadol to no reported effect except that of increased pain and illness, reduced quality of life. More than one respondent has expressed clearly that under these circumstances, the consideration of suicide and waiting for death to come is a viable option.”
Have you spoken with your insurance company? Has it been helpful? Share with us in the comments section below.