Who else is being denied care?
 

A month ago I was denied all of my pain medications by workers comp even though I was awarded lifetime medical and have had CRPS since 1996. Since 2005 I have been prescribed Duragesic Patches and Norco for breakthrough pain and that has worked for me. After a family member helped me out by buying 2 weeks worth of my patches and wearing them longer than I should, I am at my wits end. Really surprised that under the workers comp section on this forum there aren't more people sharing their stories because my attorney tells me this is happening to many people. No new posts in that section since last year. I will also post over there. In California the horror that is Independent Medical Review and Utilization Review that I have read about is now happening to me. I see a pain management dr who told me in January that he is "holding up the white flag" and giving up fighting workers comp for his patients, reducing their medications and proceeded to reduce my patches from 100mcg to 75mcg. Not because I received the treatment he requested, lumbar blocks and a radio frequency ablation, but because of pressure. Also I have caught my dr's office making quite a bit of mistakes on my paperwork to workers comp such as incomplete and inaccurate information. I am actively seeking a new doctor. According to workers comp the dr office failed to provide a random drug screen result, then when it was requested again the office sent one from another patient. I haven't received copies from workers comp even though they are cc me at the end of their letters to my doctor and I plan to discuss this with my attorney tomorrow. I end up asking the dr's office to make a copy for me of anything they received from workers comp so I know what is going on. My fault for not pushing that point earlier. Just drained lately from the stress of it all and the financial end of it. This is the first dr's office where at least 70% of the time I see a Physicians Assistant and the Dr the other 30% of the time. My adjuster actually called the PA and requested that my medications be reduced in February according to the copy of the letter from workers comp to the doctor, and further states that the PA agreed. How can a physicians assistant make that determination? At my next appointment a few days later the PA said that my adjuster had called her and asked for a copy of my CURES report (which is against HIPPA regulations) and a drug screen result. The PA never said anything about discussing my medications. So who do I believe and if workers comp says they are denying me my medications because the doctors office failed to forward a requested item, do I go after the doctor or stand in line to try to fight workers comp somehow or both? I am wearing old patches and that trick will be up tomorrow when I figure out how to magically come up with 420.00 or end up in an emergency room. Anyone else experiencing anything similar? :(

I hope you find the care you deserve!

Don't give up hope. :)

I am SO sorry that you are going through this. I am currently going through the process with work comp myself. Last August they decided to start denying everything. So my attorney is in the process of getting everything ready for trial. I've been using my regular health insurance in the mean time to still continue to get care...but as I can no longer afford them I have gone off all meds except my Lidoderm patches. It's definitely a tough situation...and unfortunately it takes TIME to sort it all out which is something that those of us in pain don't really have. My regular insurance has been pretty good up to this point but they will not approve my DRG treatment that I want to get so I am now having to appeal that...when it's a treatment that work comp should be paying anyway...and it's a mess. If you ever need to talk, just vent, etc, you can PM me any time.

If we had single payer this would not be happening, your doctor would prescribe and you would receive what you need. It's hateful and unconscionable that this is happening to you.

I was denied more PT, so I had to join a gym to exercise in a pool and to take balance classes on my own. I get my LDN on my own dime, because it is not covered by either of the two prescription coverages I have. In addition I am owed significant money in co-pays that will never be refunded to me, because it has been impossible for me to find the person in admin, who can help me.

I dread the final settlement, because I do not trust lifetime medical to ever allow me to have any treatment and at the same time I worry that a bulk amount won't be enough, but stories like yours make me think the latter is a better option, something is better than a lifetime of refusals.

We live in a country that is run for the benefit of corporations and not the people.

Please do copy your post to the WC forum here... It does need some activity, and that may bring in more persons looking for information.
search that forum or the whole site to bring up past posts -
work comp
California
Independent Medical Review
Utilization Review

When WC began telling me to reduce my pain meds I turned to my private insurance for pain meds. My dr was furious and tried over and over to get the meds to be maintained, but it was only delaying the inevitable. Previous docs I've had actually stopped doing WC because they were tired of having the things they prescribed for their patients denied over and over. It was too frustrating and made medical care impossible.
Having a lawyer can help, but still doesn't cure the problem. WC has become too powerful and seems to think we are ALL gaming the system.

The bottom line is they don't want to pay. Insurance is a bad bargain with the devil imo. If I had not lived through this WC thing I would be ignorant that injured/sick/in pain workers are treated dismissively.

You are not alone
 

I am so sorry to all of you. I know how difficult it is working with WC. It has set me back in my path of healing.

I was denied all treatment after a second IME contradicted the first WC IME and basically said I strained my arm and that I am exagerating my symptoms. I was told by my case manager he specialized in CRPS and even wrote a book about CRPS. I actually believed them and let my guard down. Big mistake. I find it difficult to get into specifics. I am so glad my husband was present. At one point we both decided to stop the exam and he reminded us we needed to complete the exam or it would be an automatic denial of coverage. We also had to ask him several times to slow down as we could not understand. He said "this is how I talk".

I have worked full time with no restrictions for 25 years same employer. I have had CRPS since 2003 and had a work related injury mid 2015 that brought it out of remission. Before my work related injury, I had pain around a 2 some days and have learned how to manage my multiple symptoms and meds. Post work related injury my pain shot up to 7, 8 and 9 and has spread. The second IME physician was unethical. My primary demanded I report him. I have been unable to work and applied for SSDI and was granted coverage first try with no lawyer.
My husbands work insurance has covered most things, but we now have a new insurance that refused to pay for my acupuncture, for example, because there is no proof that it works for CRPS. They covered multiple nerve blocks and would agree to SCS but not acupuncture that has been the only thing that drops my pain just enough to get out of bed. Medical science has failed chronic pain patients. I have to gear up to fight, but am so drained from pain and insomnia, I have made little progress. I have a lawyer after the second IME. The second IME has caused a sort of PTSD. Just awful.

Please stay strong and don't let these b******* deny our treatment. I am not giving up.

Good idea Jo*Mar
 

Hi Jo*mar,
I have posted a modified version of my original post over on the workers comp thread and thank you for that suggestion.

This article speaks to the issue of insurance companies controlling doctors.

Insurance companies’ ‘fail-first’ policy enough to make you sick | The Seattle Times

We have single payer. It comes out of something. It isn't free. We are taxed like 40-50% of our income, so we pay dearly for the system (and other social systems in place).

I doubt Americans (in general) are willing to go there, or as far.

Also, with the system in place, I *still* pay between €100-150 for my medication monthly. So it's not free by any means.

I mean it is nice to dream, but the reality of it isn't that great either. It would be far *better* than the system you have now, even though Obamacare was a step towards this.

Info about single payer: How much would Bernie Sanders’ health care plan cost the middle class? | PolitiFact

An Actual Doctor Debunks 7 Myths About Single Payer Healthcare :: Politics :: Features :: Healthcare :: Paste

Misinformation About the Cost of Single-Payer National Health Insurance | The Huffington Post

One of my online acquaintances just published a book about the issues. An American Sickness: How Healthcare Became Big Business and How You Can Take It Back: Elisabeth Rosenthal: 978159426757: Amazon.com: Books

Currently I have 3 insurances, WC, Medicare, BCBS supplemental and two prescription insurances. Despite this I am not getting the PT I need, nor am I getting my LDN paid for or getting it with a co-pay. Imo this is theft. I never minded paying for insurance that I did not need for more than four decades, I was grateful that I was healthy. Now I need help and I cannot get it, despite paying through the nose.

Regarding the tax implications, please read Bernie's plan.

I can only talk of my own experiences with single payer. It's been that way for *many years* in this country, many many decades. It eats up taxes like no other! For sure, don't let anyone tell you differently.

I still think it is a better system, and do think the US is miles behind, but it's not perfect.

I still have to pay OOP (out of pocket) for a lot of things, even though it in fact *should* be covered by a system such as this when we are taxed 40/50% of our income.

Due to the social system being burdened in the last couple of years, a number of medications have come out of the insurance system, to be fully OOP for the consumer (such as cortisone nasal sprays) -> liberal Minister of Health!

I certainly hope this trend doesn't continue.

A number of years ago, the liberals wanted to privatize health care, ie render it over to insurance companies, like the US model. Needless to say, they did not get re-elected, and lost in the election *big time*. That is how ingrained single payer is here.

I do think Bernie had great ideas! But... it wasn't meant to be. Alas.

You guys can be almost grateful (boy how bad does that sound) that Obamacare isn't yet done away with. If that helps you any.

To get back to the issue of WC and lack of treatment. My point is that as long as we have multiple insurances it puts the injured in the predicament of being a tennis ball batted back and forth between them. It is in WC's best interest not to treat, even when your doctor prescribes treatment, you an injured and weak person are put in an adversarial position-forced to fight for your needs.

I do not have the wherewithal to fight them. My stamina is low, I have just enough to do basic activities and drag myself to the gym. I cannot imagine taking on anything else.

It would be interesting to know the estimated mean cost for a year of WC, plus other insurances. We are paying for this, it is our money, we have a right to get care.

This is where I am currently at...just too weak physically and mentally to fight much as it takes everything I have to get through each day...there's nothing left in the tank anymore. I currently am dealing with 3 insurance companies all denying treatment or benefits. I have 2 attorneys (one for work comp and one for disability) and I am trying to decide what to do about my regular health insurance because as much as I want to fight it and appeal...I just don't know where THAT energy is supposed to come from. So do I continue to fight to get better or do I just accept that this right now is as good as it will be until the other attorneys see what we can work out from WC and disability because without treatment I cannot work...I can barely manage to take care of myself day in and day out. Drs should be making treatment decisions...not insurance companies...but unfortunately that is not how it works right now.

Yes, and if we had single payer we would not need multiple insurances or lawyers involved in our treatments. All that money would not be spent on admin and insurance. We would see our doctors, who would determine our needs, not some bean counter behind a desk, whose salary is based on refusing us care.

Edited to add this article about healthcare profit: Health insurer Aetna's adjusted profit breezes past estimates
| Reuters

You would think Worker's Comp would want us to get our treatments to give us the best chance of getting back to work. But they don't listen to a thing our doctor's say. Which leaves us with getting our lawyers to fight with us. And from what my lawyer says, once the denial hits a certain point there is nothing anyone can do about it. They have too much power now.
I wish we had single payer.

Trust me, single payer isn't just "we'll pay for it all, for sure". You sometimes also have to fight, this time the government instead of several insurance companies. Which makes it worse, in a sense, because you only get one chance. There is only one Goliath to fight.

We have the worst healthcare in the industrialized world. Survey Ranks the U.S. Health Care System Lowest in Performance | Time.com

Troubled workers' comp system shows need for single-payer health care | Physicians for a National Health Program

I know, I know. But often single-payer is seen as "utopia", which it most certainly is not. It has its faults just like any other system.

In 2015 the average cost of insurance in the USA was 9,000. In Australia the average cost was approx. 4,400. we are paying double for less and for those of us on WC there is that additional cost. It's hard to realize that a great deal of money is being spent, yet we are not getting treatment.

I was injured at work almost 5 years ago. It is an uncontested case as far as it is clear cut that I was injured at work and developed CRPS after surgery for that injury. My employer did not fight the fact that I was injured at work.

I worked for a very large hospital system (it owns hospitals all over the country). They are self-insured for WC meaning that every treatment/drug etc. has to be approved through the WC system and then the hospital has to agree. Absolutely #@$%!

Every time my doc submits something it gets denied. Even if UR agrees it is appropriate treatment my case worker (with no medical training) denies it. I haven't had any treatments or meds approved in 3 years! I do not get how someone with no medical background can make medical decisions. It's crazy! I have to get the denial from WC and then use my health insurance with it's crazy high deductible followed by Medicare (which pays for almost nothing).

Of course I am in litigation, but that moves slower than *#@! here. In one week it will be two years since my case was first heard by the judge (it took over a year to get on his docket). He has had my completed case on his desk since January and my lawyer says not to expect a decision until at least late summer (and then my employer will appeal it taking another 3-4 years).

Even if I win my case, WC can continue to deny every claim I submit. The whole system is rigged against the injured worker!

Anyway, there is a mail order pharmacy named IWP (Injured Workers Pharmacy) that will supply your meds and then fight with WC for payment. There are several other pharmacies like IWP, but I have found them reliable.

Best of luck to everyone fighting this awful WC system.