I have Kaiser Permanente insurance. Last June I asked for a dose increase on my Morphine SR (from 60mg/day to 90mg/day, one tablet more). My Primary Care Provider (PCP) said "the computer" wouldn't let her do it unless I took pain management classes. So, I waited 4 months out for available classes, barely survivng at my dosage, I took the classes and asked, again, for the increase. My PCP says she won't change my dose and she won't give me the referral I need to see a Pain Management doctor (Pain Specialist) who "the computer" says I need to see to make the dose changes. The deal was that I go to classes, I get the increase, because that's what "the computer" wanted. But, I can't get the increase without seeing a Pain Specialist to whom my PCP won't give the referral. What do I do to get her to give me the referral? She had me on 90mg/day before, we tried dropping down and when we tried to go up again, all this happened. Am I making any sense? Who do I talk to and where are the resources through Kaiser Permanente to get advice on their own processes? I am stuck and hurting. I am familiar enough with my body, my pain and my medications to know this is what I need right now. What do I do? Where do I get advice thru Kaiser Permanente? I am SO FRUSTRATED!
Sorry about your pain. I have had Kaiser insurance for many years and was a nurse there for 16 years. You can always change doctors if you are not happy with yours. I won't stay with a doctor that I can't communicate with or doesn't help me. You can call Membership Service and tell them your health situation and ask for help. Do any of your friends have Kaiser and have good doctors? I asked a nurse at Kaiser who were the good doctors and he gave me a list. At Kaiser you have to stand up for yourself or you can get lost in the shuffle. Also that doctor does have a supervisor that you could talk with. I have had to do all of these things for my family and myself over the years. Hope this helps.
Dear shaunna, my friend had this problem with her kids pediatrician( would never give antibiotics, to er with temp104 twice). She just called & changed primary. Good idea to ask nurses @ hospital or insurance who is used most in your area, if they will do that? You didnt say source of your chronic pain? Thank you,shaunna
Sorry to hear about Yet another Kaiser Issue like this, First I do not know of any Computer Limitations Stated by your PCP as far as requiring you to take Pain Management classes, then coming up with a new excuse claiming computer won't allow PCP to increase dosage it must be a Pain Management Physician ( Unless some new software has been installed in the last year or so)
I personally have Kaiser and have a Friend who has kaiser and the Horror stories I could tell you about my Friends PCP Issues and Incompetence of the Pain Management Department/Doctor would Shock you.
I will tell you do not waste your Time Filling a Grievance of complaint as I have found it is a complete waste of time they do not get Facts Correct nor do they actually investigate any of the claims they just look at the Medical records and call it fact no matter how many Incorrect Statements Kaiser Doctors Enter along with Assumptions that have not factual basis.
I would Personally Try to call Member Services ( though they have been no Help for me in dealing with my Friends Issues) and request to have a referral to pain management (if you feel they will actually help you) Since your PCP refuses to give you one.
I also HIGHLY Recommend you Either Go into the records department and look at your records (which you have to set up an appointment but does not cost you anything) or get a complete copy of your medical Records if you can afford it and read it very carefully and Throughly to be sure everything in there is Accurate Especially things you have said to your PCP and the PCP's chart notes comments ( I was appalled by what I found to be totally incorrect and Some was Pure Assumptions with no Facts to back them up along with Doctors stating Opinions which are 100% False)
What is the Saddest about what I have Found is I personally have had no real Issues with my PCP and I was the one who Suggested my Fried switch to Kaiser awhile back which sadly was the Worst advice I could of given anyone, I will never Suggest Kaiser again and Even though my PCP and I get along great and all is Good Kaiser has done so much Damage to My Opinion of them and my Belief in their competence I will never allow them to do any Surgeries on me or any treatment that has to do with anything being Injected into my Spine etc. but those Issues are for a completely different thread.
To sum it up Be sure what your records have in them, Request to have someone above your doctor get a referral processed for you since your PCP refuses to do it, Look at Finding a Different PCP as far as I Know your PCP lied to you because they did not want to tell you they did not feel like putting you back on your dosage you were previously on, and Finally do not think you will get any Help by Filing a Complaint/Grievance as I have found it is a Complete Joke and Total waste of your Time.
Sorry I could not give you better news or tell you exactly whom to contact to fix this issue, I just hope it works out better for you then it has for my friend I have been Fighting with Kaiser over for about 10 months or so now.
Last edited by Cachexia; 11-15-2012 at 08:20 PM.
Reason: Spell Check
Hello, I suffer from extreme insomnia and chronic pain from a car accident and migranes from hitting my head in the car accident,my doctor wont prescibed me anything more than ibruprofen gabapentin and amitriplin, I was given morephine 2 weeks ago from a friend, and it worked tremendously, I advised my doctor this but he still wouldnt do anything expect refer me to a nerve damage doctor, I advise you to ask your doctor to prescibed what is needed or you will make a complaint to an ombudsmen, he or she will step in an overlook your situation and can make changes to the computer problem, or if all else fails go to the emergency room with your statement and they may help you.