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California - Lifetime Med - Coverage Terminated
#7
(01-23-2019, 01:36 PM)1171 Wrote:
(01-23-2019, 10:55 AM)spine pain Wrote: Where to start - California Workman's Comp- settled with lifetime medical in 2000. They initially covered my pain management procedures - then after a few years, it became a nightmare to get covered. They have been covering my medications until this month. Without notice, they stopped covering the opiods that I have been taking for 15 years.


Can they do this without any notice? I am not working and in the process of going on SSDI, due to the issues I am having with my health, related to this injury. I do not know where to tuen on this. I do not live in California anymore, so I do not know where to turn.


Thanks for any advice that can be provided

Treatment approvals and the documentations are handled between the physician & the carrier, generally the patient is not part of that correspondence. I suspect a recent update to the drug formulary was not adequately addressed by your treating physician.
The formularies are here
https://www.dir.ca.gov/dwc/MTUS/MTUS-For...rders.html
You should contact your doctor about getting preapprovals from the carrier for
The highly controlled long time use of opioids. The treatment guidelines do allow for a surpervised plan to reduce patient dependencies on opioids.

I think this is the issue - both of meds are non exempt. Like I mentioned in the other thread, UA has been an absolute nightmare. I called the adjuster and they mentioned that they would gladly settle the lifetime, if I would like. Timing is just really bad.
I have been compliant on the use of the meds and I have even reduced down to the CDC guidelines. My injury is one that I will have pain the rest of my life.
 
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RE: California - Lifetime Med - Coverage Terminated - spine pain - 02-18-2019, 02:03 PM

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