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.

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.