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Cancellation of Medications
#1
Hello all,

I'm looking for some insight or personal experiences to guide my father on his current situation with workers comp. He recently received a letter stating workers comp has cancelled 95% of his medications. He was deemed 100% disabled several years ago and is in some pretty hard core pain killers due to a diagnosis of chronic pain syndrome. He was told there is a new law that allows insurance companies to deny medications just because someone has been taking them for a long time. Is anyone else going threw this? Or has had experience with a situation like this?

Thank you in advance

Yesi
 
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#2
(12-30-2017, 03:58 PM)yyesii209 Wrote: Hello all,

I'm looking for some insight or personal experiences to guide my father on his current situation with workers comp. He recently received a letter stating workers comp has cancelled 95% of his medications. He was deemed 100% disabled several years ago and is in some pretty hard core pain killers due to a diagnosis of chronic pain syndrome. He was told there is a new law that allows insurance companies to deny medications just because someone has been taking them for a long time. Is anyone else going threw this? Or has had experience with a situation like this?

Thank you in advance

Yesi
Let me guess, he lives in California?

They have updated guidelines for medications in California. I was not aware they already took effect.

They have been denying patients medications for a while, but new guidelines I assume are going to make it easier. It is unfortunate to read about patients who have serious conditions and are being denied. If he has alternative insurance he should be able to use it after a denial (check first).

Please read his denial completely. Is it a utilization review denial or a IMR denial from MAXIMUS? Does the denial state to lower his medications or stop them immediately?

There are ways to appeal these denials, if his condition warrants it. If it is a utilization review denial there is a short window. It states how to appeal but he should contact his doctors office for help. Does he have an attorney? If so he can also be contacted and ask for guidance. 

Does he have CRPS?

1171 just wrote a post a few down that includes new guidelines for opioids. They are supposed to taper them down and not cut them off cold turkey.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#3
I wish I could give you some insight, but I have not been denied medications. Hopefully that does not happen.

I know there is a large amount of people that have had their medications denied in Texas.

I take a few medications and one of them is a opioid. The pain management dr that I see has changes the way he does business. Every time I go there I have to leave a urine sample. I am then given two scripts for the opioids (2 month supply) that I must hand deliver to the pharmacy each month. Also I have to take in my medications for every visit so they can count the amount that I have. I have been told that if I receive a phone call from them that I will have 24 hours to get there for another urine sample (that has not happened yet).

I wish I could answer your question, and I wish your father the best.
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
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#4
(12-30-2017, 08:58 PM)AQA Wrote: I wish I could give you some insight, but I have not been denied medications. Hopefully that does not happen.

I know there is a large amount of people that have had their medications denied in Texas.

I take a few medications and one of them is a opioid. The pain management dr that I see has changes the way he does business. Every time I go there I have to leave a urine sample. I am then given two scripts  for the opioids (2 month supply) that I must hand deliver to the pharmacy each month. Also I have to take in my medications for every visit so they can count the amount that I have. I have been told that if I receive a phone call from them that I will have 24 hours to get there for another urine sample (that has not happened yet).

I wish I could answer your question, and I wish your father the best.

I have wondered about medical providers who do urine checks on EVERY patient, EVERY month. Could this be some sort of billing scam?Urine tox screens are big money makers for doctors and some are taking advantage (JMO). I am no expert, but I read urine tox screens should be random, or used for those who exhibit signs of misuse. I had a medical provider who was doing this. I did not mind because I had nothing to hide... but when I was pro per I received copies of his billing. I was very confused by it and looked up the codes. I found he was billing tox screens more than office visits, so this can be a money maker.

Would like to get other opinions on this, if this is needed or more of a billing scam?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
Md is doing the same thing.
urine screen, then hand deliver the script
Opioids have become 7 days for new patients, 30 for existing
They are tapering people off, with no replacement to speak of.

The war on opiods is not the war on pain.
 
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