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California UR Doctor prescribes breaking time-released Opioid? Legal? - Printable Version

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California UR Doctor prescribes breaking time-released Opioid? Legal? - TreadingWater - 08-02-2017

The UR doctor based out of Northern California has requested I bite or tear apart time-released opioids as a way of tapering. My PTP has said he will "fire me as a patient" if I break apart any time-released medication he prescribes". The UR doctors report is full of lies, he claims "Doctor does not ask for drug testing" I get drug tested every two to three months randomly and never have failed one. UR doctor said "doctor has never tried to taper medication".


My doctor has tried to taper medications but than the adjuster deny's the medications causing me to end up in worse shape. They have had me go "cold turkey" many times during our goal to reduce pain medications of both pain and psyche meds.


I realize the UR's Doctor's request to tear up my time-released medications is crazy, will the IMR uphold his request? What if the same doctor asking me to break up my pain medications is the IMR Reviewing doctor? How would you write to the IMR even though you know that 90+% of all requests are upheld.


RE: California UR Doctor prescribes breaking time-released Opioid? Legal? - 1171 - 08-02-2017

IMR reviewers are contracted out. If you believe there is a conflict or bias you can object/appeal. more on objecting to an IMR determination here
http://www.dir.ca.gov/dwc/IMR/IMR_FAQs.htm


RE: California UR Doctor prescribes breaking time-released Opioid? Legal? - California_Help - 08-03-2017

(08-02-2017, 03:57 PM)TreadingWater Wrote: The UR doctor based out of Northern California has requested I bite or tear apart time-released opioids as a way of tapering.  My PTP has said he will "fire me as a patient" if I break apart any time-released medication he prescribes". The UR doctors report is full of lies, he claims "Doctor does not ask for drug testing" I get drug tested every two to three months randomly and never have failed one.  UR doctor said "doctor has never tried to taper medication".


My doctor has tried to taper medications but than the adjuster deny's the medications causing me to end up in worse shape.  They have had me go "cold turkey" many times during our goal to reduce pain medications of both pain and psyche meds.  


I realize the UR's Doctor's request to tear up my time-released medications is crazy, will the IMR uphold his request?  What if the same doctor asking me to break up my pain medications is the IMR Reviewing doctor?    How would you write to the IMR even though you know that 90+% of all requests are upheld.

The UR doctor is not sent all of your records and can only go by what he receives from your doctor and claims adjuster. The claims adjuster is supposed to send relevant records. So for example if your doctor did not state in his request you are drug tested every 3 months and have attempted tapering in the past, the UR doctor will use a boiler plate denial stating those as reasons to deny. How can it benefit you when UR or IMR did not receive all relevant records? Your doctor may be able to send your request again even if IMR denies it and on the RFA check off the box stating change of condition or material facts known. The UR doctor did not receive the material facts known.

There is another way to appeal UR denials, and I recommend it highly in situations such as the UR doctor did not receive or failed to acknowledge relevant records sent. If you read the last few pages of your UR denial it should state how to do an internal UR appeal directly with the UR company. The timeline to do this is usually 5-10 days after date of UR denial. YOU, your attorney or doctor can write an appeal to the UR company and send the relevant missing records to back up your assertion. It is best to have your doctor do this, especially when it comes to medication denials. He should also include medical treatment guidelines to back up the request. This is same for IMR but I have found IMR did not read the records I send, unlike UR. I believe they can get away with this because with IMR the doctor does not include his name. With IMR there is more accountability. In my opinion it is much easier to get a denial overturned in the internal UR appeal process than with IMR. Many doctors do not use this appeal process.

So there are serval ways to appeal UR denials. There are also several ways to get a second bite of the apple without waiting the 12 month period IF IMR upholds the denial. As I mentioned if not all of the relevant or material facts were sent or known to the UR or IMR doctor, there is a box on the RFA to request it. Also, if your doctor believes you have a substantial change of condition, he can make a request again without waiting the 12 month period as there is a box on the RFA for change of condition. I am not a physician but often times lowering or discontinuing medication can lead to high increase of pain, which in my opinion is a change of condition. Make sure you appeal with IMR timely.

I recommend following the guidance of your treating doctor on how to wean down from your opioid. Did you google the UR doctor who wrote you should break the time release medication and check his medical license for what specialty he is? I recommend it as incorrect specialty may be a way to appeal this too.

My personal opinion on long term opioid use is it can be a good idea to attempt to lower the dose under your doctors supervision, to see if they are still working. My experience was a spike in pain that did level off in time. Every injury is different as is every patient so you may very well need them.

Did you receive my private message to another question last month?