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have CRPS/RSD
#1
Hi. First post. A bit desperate. I won't use any names here as this case is closed, but because of appeals, etc. ongoing. For over ten years.

The firm I worked for pleaded guilty to making me disabled. I have CRPS/RSD in right ankle, and was a life changer. Over ten years ago. I'm in KY. I'm broke. Can't drive a normal car, can't keep balance. I don't want to wind up in some old folks' home over an idiot on a forklift. But, i was crippled. Forever. I'm on Medicare A/B and have been since 2010. I recently turned 65.

The settlement was a joke, and the insurance co. wants me on pain killers. Did that for over 7 years. I barely knew who I was. Pain management doctor prescribed a compounded cream that is a miracle. The trouble is insurance co. is being charged 2800 dollars a month for the stuff by a pharmacy out of state. The insurance co. re-opened the case because of the cost, but I didn't choose the doctor, they did, and with all the hoopla over opioids here, it gets downright disgusting. Let me say I do NOT want to take opioids. The gist of my question is simply this: my atty has told me that the pm doctor has personally made over 80,000 off me in the past year or so, more than my entire net settlement 8 years ago. Atty says this is illegal. I say some doctors can have a financial interest in the company and not be liable. KY is a loophole state, believe me. Right now the case is settled (the doctor the Ins Co. sent me to wants me to stay on the compounded cream, it backfired on the ins co.) but an administrative law judge is supposedly trying to figure out a way to get him/her to prescribe a cheaper pharmacy. There are pharmacies in KY who make the stuff, 10 times cheaper. But he/she refuses to write a prescription and just let me go get it...does anybody know in KY is this legal? I don't care where the stuff comes from as long as it works, but it is galling the money he/she makes off me. I'm getting by on less than $1000/mo. I have one of the top rated work comp attys in the state. But they aren't exactly my "friends" and they seem to not know the answers to these very simple questions. Can a pain management doctor have a financial interest in a company he/she prescribes to/from?He/she admits he/she does. It's the only pharmacy he/she uses, but like I said, it's 2800 as opposed to 250 a month I could get the cream for, here. He/she will not write a prescription for it. He/she calls it in to the pharmacy out of state, and it is overnighted to me by Fed Ex. One would think a good work comp atty would know the answers to this very simple question. It's getting on my nerves, and as we know, anxiety makes pain much worse. They feed off each other. I can't afford to lose my pm doctor. I should relate that a wcomp atty in KY cannot make more than 10K in any one case. So, since this case is basically closed, there is no incentive to "work" on it. It's seen as a courtesy. Should i just try and relax, see what happens? I'm gonna be getting the cream one way or the other, but I am confused and concerned. Any help would be appreciated. I just realized my user name gives me away. Oh well. Any reasoned thoughts? Regards.
 
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#2
you might be able to find out more about your doctor's financial incentives here
https://www.propublica.org/datastore/dat...s-for-docs.
some medical providers are barred from some collateral ownerships but not others.
laws sometime only require disclosure and allow payors to to make their own determinations as to whom to use/approve.
fighting to save your carrier some medical $$ is admirable but you have to decide if its worth the effect on your health.
contact your local medical board to find out about your state's laws on physician ownership
https://kbml.ky.gov/Pages/index.aspx
https://pharmacy.ky.gov/Pages/KBML-Board-Actions.aspx
http://www.kyiasiu.org/home/report-fraud
if you want to pursue the matter, it sounds like you'll have to do your own research.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
Glad that information was helpful.
Post again.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#4
(09-19-2018, 11:56 PM)harperbass Wrote: Hi. First post. A bit desperate. I won't use any names here as this case is closed, but because of appeals, etc. ongoing. For over ten years.

The firm I worked for pleaded guilty to making me disabled. I have CRPS/RSD in right ankle, and was a life changer. Over ten years ago. I'm in KY. I'm broke. Can't drive a normal car, can't keep balance. I don't want to wind up in some old folks' home over an idiot on a forklift. But, i was crippled. Forever. I'm on Medicare A/B and have been since 2010. I recently turned 65.

The settlement was a joke, and the insurance co. wants me on pain killers. Did that for over 7 years. I barely knew who I was. Pain management doctor prescribed a compounded cream that is a miracle. The trouble is insurance co. is being charged 2800 dollars a month for the stuff by a pharmacy out of state. The insurance co. re-opened the case because of the cost, but I didn't choose the doctor, they did, and with all the hoopla over opioids here, it gets downright disgusting. Let me say I do NOT want to take opioids. The gist of my question is simply this: my atty has told me that the pm doctor has personally made over 80,000 off me in the past year or so, more than my entire net settlement 8 years ago. Atty says this is illegal. I say some doctors can have a financial interest in the company and not be liable. KY is a loophole state, believe me. Right now the case is settled (the doctor the Ins Co. sent me to wants me to stay on the compounded cream, it backfired on the ins co.) but an administrative law judge is supposedly trying to figure out a way to get him/her to prescribe a cheaper pharmacy. There are pharmacies in KY who make the stuff, 10 times cheaper. But he/she refuses to write a prescription and just let me go get it...does anybody know in KY is this legal? I don't care where the stuff comes from as long as it works, but it is galling the money he/she makes off me. I'm getting by on less than $1000/mo. I have one of the top rated work comp attys in the state. But they aren't exactly my "friends" and they seem to not know the answers to these very simple questions. Can a pain management doctor have a financial interest in a company he/she prescribes to/from?He/she admits he/she does. It's the only pharmacy he/she uses, but like I said, it's 2800 as opposed to 250 a month I could get the cream for, here. He/she will not write a prescription for it. He/she calls it in to the pharmacy out of state, and it is overnighted to me by Fed Ex. One would think a good work comp atty would know the answers to this very simple question. It's getting on my nerves, and as we know, anxiety makes pain much worse. They feed off each other. I can't afford to lose my pm doctor. I should relate that a wcomp atty in KY cannot make more than 10K in any one case. So, since this case is basically closed, there is no incentive to "work" on it. It's seen as a courtesy. Should i just try and relax, see what happens? I'm gonna be getting the cream one way or the other, but I am confused and concerned. Any help would be appreciated. I just realized my user name gives me away. Oh well. Any reasoned thoughts? Regards.
I sure would like to know what that cream is, as I too do not want to be hooked on any Pain killers!
 
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