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Old 09-19-2009, 08:16 PM   #1
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My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

I just got the news that my doctor will no longer see me after October 1st, 2009. He told me they can no longer accept Worker's Comp because it's too much paperwork and not enough money for them. I feel like I was dumped in favor of money. I wasn't given enough time to find a new doctor in time.

The problem is that he's been filling my pain med prescriptions for the entire time and I had a really hard time finding him in the first place. Before finding him, I had gone to 5 other Dr's and pain management centers and 3 of them accused me of drug seeking and the other 2 said they would take me on as a patient, but they wouldn't fill my scripts which would have been worthless.

Here's a little history just to give you an idea of my current condition.

5/10/98 I hurt my back while lifting boxes at work.
8/2000 After continuing to work after my injury I had to stop when my legs went numb and my back pain got to be so bad I couldn't stand it.
8/17/2000 I had an emergency discectomy/laminectomy of the L5/S1.
11/2000 I had an infection in the disk space that was operated on.
6/22/2001 Another back surgery - micro discectomy & biopsy
4/16/2002 3rd back surgery - Spinal fusion + cage
4/13/2006 Spinal Cord Stimulator implant

I have been on pain meds since my first surgery and currently take
100mq Duragesic patches 1/every 2 days
7.5/325mg Percocet MDD 8
350mg Soma (muscle relaxers) MDD 4
75mg/25mg Lyrica
+various Rx stomach meds, Vit D, Androgel

I am having trouble locating a new doctor who will even take Worker's Comp let alone fill all these medications for me. Along with all the pain I'm in constantly, now I stressed out that I won't find someone who will continue this. The meds I currently take are just keep me at baseline.. if I have to stop any of it and cut back I don't know how I'll be able to deal with it.

Does anyone have any tips on finding a new doctor that accepts Comp and have them continue where the last doctor left off? There have been so many doctors in this area that have lost their licenses revoked by the DEA. I guess I don't blame the doctors for being afraid to treat with pain meds.

Thanks for taking the time to read this,
Matt (upstate NY, USA)

 
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Old 09-20-2009, 01:43 AM   #2
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

That is disgraceful

A few thoughts (I am in Australia, so things are different here) but...

Is he refering you on to another pain specialist? Is it ethical for him to simply abandon you? Ring the state medical board and ask for help, they might atleast be able to offer you names of other pain specialists.

Can you pay cash for you visits while searching for another pain management doctor?

Do you have a family physician who will prescribe for you?

Very glad we dont have a DEA type orgainisation here overseeing prescribing of medical narcotics.

Last edited by guy in AU; 09-20-2009 at 01:48 AM.

 
Old 09-20-2009, 02:15 AM   #3
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Spoon, have you thought about going thru work comp? Make them find you a decent doctor? I'm not sure of all that you have been thru on that end but if that is the prob and your work comp is still on going... make them help you, or your case manager. Just my 2 cents. I hope u feel better, I'm not at the same level you are at, but I do understand. Truly I do. Mine is my neck and getting worse instead of better... May we both feel better someday...

Last edited by MCandyG; 09-20-2009 at 02:19 AM. Reason: responded to wrong person...

 
Old 09-20-2009, 07:16 AM   #4
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by spoonmanx View Post

I feel like I was dumped in favor of money. I wasn't given enough time to find a new doctor in time.
Unfortunately, you are being dumped due to money. Whatever happened to the medical oath of "do no harm"? I'd try to get in front of this Doc ASAP and see if he could at least see you until you are properly transitioned. I would remind him that fentanyl is the strongest pain med out there and one just doesn't stop taking it. I'd make him look me in the eye and tell me that he's dropping me or say "no" to some type of continuing care.

Or, you could tell them that you'll just pay cash or bill it to regular insurance from here on out. You could do this permanently, or until you get transitioned. If you don't have insurance, you might ask him that given your long term patient history with him, could you work out some type of deal....Something reasonable so you can continue on as a patient.


Quote:

The problem is that he's been filling my pain med prescriptions for the entire time and I had a really hard time finding him in the first place. Before finding him, I had gone to 5 other Dr's and pain management centers and 3 of them accused me of drug seeking and the other 2 said they would take me on as a patient, but they wouldn't fill my scripts which would have been worthless.


All of this is the past, and I wouldn't tell too many people this, especially prospective Docs, nurses, or appointment people. Unfortunately, the field of PM is of edge right now, and you don't want to scare anyone off. You've had a good record for seven years which is a long time in PM. I'm not suggesting that you did anything improper.....There is no need to mention the other stuff....It just clouds the water. If anyone asks about your prior medical treatment, just tell them that it took you a bit of time to find a good Doc and don't give any details.


Quote:

I am having trouble locating a new doctor who will even take Worker's Comp let alone fill all these medications for me.


The problem is that workers comp has become a nightmare to deal with....Constant paperwork and updates. They do this on purpose so people get frustrated and drop off....Just like what's happening to you.

I would first get my Doc straightened away re: accepting regular insurance and / or cash until I got transitioned. Then, I would write & call my congressman, state senators, and the President. I'd copy my Doc on everything. Make the Doc look like the hero and bash workers comp and the insurance industry. It's a hot topic right now. Also, maybe your Doc will hang in there once he sees his name copied on all these letters....I doubt he'd want his name up in lights.

Take care, and I hope this all works out for you.

Regards,

Ex

Last edited by Executor; 09-20-2009 at 07:19 AM.

 
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Old 09-20-2009, 04:19 PM   #5
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by MCandyG View Post
Spoon, have you thought about going thru work comp? Make them find you a decent doctor? I'm not sure of all that you have been thru on that end but if that is the prob and your work comp is still on going... make them help you, or your case manager. Just my 2 cents. I hope u feel better, I'm not at the same level you are at, but I do understand. Truly I do. Mine is my neck and getting worse instead of better... May we both feel better someday...
Thanks and good luck with your pain. I am still hopeful even after 11 years of pain.

 
Old 09-20-2009, 04:28 PM   #6
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Hi Ex, thanks for the reply.

Quote:
Originally Posted by Executor View Post
Unfortunately, you are being dumped due to money. Whatever happened to the medical oath of "do no harm"? I'd try to get in front of this Doc ASAP and see if he could at least see you until you are properly transitioned. I would remind him that fentanyl is the strongest pain med out there and one just doesn't stop taking it. I'd make him look me in the eye and tell me that he's dropping me or say "no" to some type of continuing care.

Or, you could tell them that you'll just pay cash or bill it to regular insurance from here on out. You could do this permanently, or until you get transitioned. If you don't have insurance, you might ask him that given your long term patient history with him, could you work out some type of deal....Something reasonable so you can continue on as a patient.


[/i]

All of this is the past, and I wouldn't tell too many people this, especially prospective Docs, nurses, or appointment people. Unfortunately, the field of PM is of edge right now, and you don't want to scare anyone off. You've had a good record for seven years which is a long time in PM. I'm not suggesting that you did anything improper.....There is no need to mention the other stuff....It just clouds the water. If anyone asks about your prior medical treatment, just tell them that it took you a bit of time to find a good Doc and don't give any details.


[/i]

The problem is that workers comp has become a nightmare to deal with....Constant paperwork and updates. They do this on purpose so people get frustrated and drop off....Just like what's happening to you.

I would first get my Doc straightened away re: accepting regular insurance and / or cash until I got transitioned. Then, I would write & call my congressman, state senators, and the President. I'd copy my Doc on everything. Make the Doc look like the hero and bash workers comp and the insurance industry. It's a hot topic right now. Also, maybe your Doc will hang in there once he sees his name copied on all these letters....I doubt he'd want his name up in lights.

Take care, and I hope this all works out for you.

Regards,

Ex

He seemed like a good and helpful doctor, but I guess it's a business and they must run it as such.
When he told me the news he avoided eye contact and seemed ashamed of it. He told me it was a hard decision.
I later received an official letter from him telling me I can continue to see him for other primary care
needs, just nothing W/C related. I don't want to continue to go there for anything after being let down like this.

The trouble with continuing with him, is they won't fill any future w/c related prescriptions so that's the problem.
I do have Medicare, but they don't pay for any of my worker's comp stuff since it's already established with Traveler's W/C

Thanks for the tips. I am going to make a lot of calls on Tuesday. Tomorrow (Monday) is my birthday and I don't want to deal with any of this for at least that single day. A small gift to myself I suppose. :P

Matt

Last edited by spoonmanx; 09-20-2009 at 04:29 PM.

 
Old 09-20-2009, 07:25 PM   #7
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Try to forget your troubles and have a happy birthday!!

 
Old 09-20-2009, 07:45 PM   #8
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by spoonmanx View Post

I could pay cash for the visits, but I was told the pharmacy wouldn't be able to put the prescriptions through my comp and those would cost me roughly $3000 a month.. which obviously I can't do.
I'm not sure I understand. If you pay "cash" for the visits...or bill them to Medicare, why can't the pharmacy bill them to WC then? A Rx is an Rx.

Also, open enrollment in Medicare starts in October, and you could switch to a plan that would cover most, if not all of those meds. I don't think there are any pre-existing clauses that I'm aware of.


Quote:
The SCS is primarily used for radiating nerve pain which (most) all
patients understand. (Depends on what their docs tell them. It
appears from my research that some docs throw this at all kinds of
patients, as an option whether it really makes sense or not. If they
have run out of other ideas, they push this inappropriately.
I can certainly understand why you feel this way....I would feel the exact same way. However, I'd make another appointment to see him and practically beg if I had to. Tell him that this is everything to you and you doubt that you can get transitioned to another Doc. I'd even remind him of his "do no harm" oath that he took when he became a Dr. I'd ask him point blank...."what happened to 'do no harm'?

I'd ask him that since you're such a long time established patient, could you be "grandfathered" in? Again, I would beg, plead, do whatever I had to for him to keep you on. I know it's a lot of paperwork, but you're just one patient.....And you have a very complex situation and could be seriously harmed if not accepted by anyone.

I realize that not everyone would want to take this approach, but I would pull out all the stops. Even with the graveling, all he can do is say "no." And then, he has to live with himself if he follows through....He has to be able to sleep at night knowing the decision he is making. Simply "going away" makes life easier for him, and I wouldn't. Squeaky wheel gets the oil.

Take care, and I'll be thinking of you.

Regards,

Ex

 
Old 09-21-2009, 04:48 AM   #9
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

How often do you have to see him for pain management? Could he issue with repeatable prescriptions, so that you could see him every 3 months or even 6 months, and pay cash for the visit.... that would be less of a burden than paying cash for every month, and it sounds like you have a stabal history.

 
Old 09-21-2009, 08:57 AM   #10
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by spoonmanx View Post
Thanks for the tips. I am going to make a lot of calls on Tuesday. Tomorrow (Monday) is my birthday and I don't want to deal with any of this for at least that single day. A small gift to myself I suppose. :P

Matt
I hope you have a great birthday today. I really do not have anything to add, but did want to say that I am sorry that this is happening to you. It just seems like this is happening more and more, whether it be your situation with WC or just offices' closing down, for whatever reason. I hope everything works out and I would speak to the DR about hopefully staying with him but paying cash. I hope something can be worked out, so you do not have to start over, if you can even find a dr in your area. Good luck!!
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Old 09-22-2009, 03:26 PM   #11
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

I had asked my doctor if I could continue with paying out of pocket or with Medicare and he told me that once his WC termintaion paperwork goes through, he will not be legally able to write prescriptions for anything worker's comp related. I don't know if he's just telling me that to avoid the extra paperwork or not.

Also, I couldn't afford to pay out of pocket since I know they charge $90/month for W/C so I assume it might be even more for a regular visit. I think that's a big reason why they are getting rid of W/C patients in the first place. They want more money. I am living on $500/month SSI (out of work for 9 years now) so even $90/month extra would put me in financial trouble.

From what I was told, if Medicare pays for the visit, then worker's comp will not pay for the medications. I checked out the Medicare Rx plan and it really doesn't help me much. I require the brand name meds for Percocet and Duragesic. Medicare only pays a majority for generics (when available).

I really don't think begging him to take me back is a good idea. Keep in mind, he was also my Primary Care doctor. I need a doctor I can trust my life with. He isn't that person anymore. I don't need a doctor that is just willing to accept my money. Maybe now I will find a doctor that can not only take over his duties, but might even do more for me than the last one. I don't know... I'm continuing to look.

Thanks again for the help

-Matt

 
Old 09-22-2009, 07:51 PM   #12
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by spoonmanx View Post

From what I was told, if Medicare pays for the visit, then worker's comp will not pay for the medications. I checked out the Medicare Rx plan and it really doesn't help me much.
That makes perfect sense....I think this information is correct. It's just a shame that he can't work out something for you, given your LT track record there.

At the very least, however, I'd ask (almost demand in a nice way) that he care for you until you are transitioned (maybe an extra month or two). He has taken the oath of "do not harm" and given the high level of fentanyl you're on, you could experience some severe problems if you don't stay on them, or are forced to WD. I would hope that he would at least give you some extended Rxs to get you through.

I don't mean to scare you, but your transition is critical.

Best of luck to you.

Regards,

Ex

 
Old 09-23-2009, 12:32 AM   #13
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Sorry if I've missed something here but are you still on workers comp? Don't they have some responsibility to make sure you still receive care? I'd be ringing them (my case manager) and explaining what's happened and asking them to find you someone asap or else they're going to have massive hospital bills when you go into wds. I would also ring every dr in my area (preferably PM) and asking if they take established (proven that you're not a seeker) workers comp patients. I'd also ask your doc to write a letter stating that you've been the perfect patient and he believes that you are at no risk of seeking and are simply looking for a PM dr. It's the least he can do for you.

Unfortunately money is a problem (and it's only getting worse for many with drugs like Actiq being taken off insurance for non cancer sufferers) so if it comes down to it you may need to get heavy with the WC company. You were injured at work so they have a responsibility to make sure that you're treated for anything WC related. This is a legal responsibility. I'd drop into my local congress/write to my senator and explain their breach of treatment and ask for help. If it gets really bad you could threaten media....

It is so unfair that you've been put in this situation. If I were you I'd do everything in my power to have my current doc (I know he's let you down) help, he needs to give you a letter to take to PM offices (better if you go in person - then you might be able to work out a small cash payment for the extra WC paperwork, or something). I'd also ask him straight up what happens when you've exhausted all your options and you can't find anyone to treat you - do you just go to hospital and explain that your doc won't treat you anymore? This wouldn't look good for him.

I live in Aus so it's a bit different - I was on WC and in the state I live in it only covers you for 9 years, pretty unfair, hey. I know what you're going through stress wise about how you're going to survive in the future. Thankfully I also had workers insurance and am counting on them (they'd better payout soon) to get me through. If you're still covered by WC then get on their backs...it's their fault that this has happened and they may possibly be able to work something out with your current doc - it'll be a lot cheaper for them if you stay with him rather than have a PM. Hopefully that alone might be enough to get them working for you rather than against you. No company wants the risk of more expense.

One more question, do you have a relationship with the PM that put in the SCS? Could you go to them for help? Just a thought.

Happy Birthday, I really wish you didn't have this stress at the moment.

Jem

 
Old 09-23-2009, 08:06 AM   #14
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Quote:
Originally Posted by Jema X View Post

Don't they have some responsibility to make sure you still receive care? I'd be ringing them (my case manager) and explaining what's happened and asking them to find you someone asap or else they're going to have massive hospital bills when you go into wds.
This is a great idea by Jema. Since WC has all these screwy rules, I'd put the squeeze on them. Maybe they can work with your Doc for less paperwork and etc. I have a friend who is on lifetime WC for a back problem, and they were requiring monthly reports. The PM Doc finally called them and said "hey...This isn't gonna change...It's forever....All this paperwork is just costing us both time and money" and they made some type of exception for him. I'd look into this.


Quote:
I'd also ask your doc to write a letter stating that you've been the perfect patient and he believes that you are at no risk of seeking and are simply looking for a PM dr. It's the least he can do for you.
At the very least, this is what your Doc should do. If he's truly dumping you for paperwork / financial reasons, he has some obligation to get you transitioned.


Quote:
It is so unfair that you've been put in this situation. If I were you I'd do everything in my power to have my current doc (I know he's let you down) help, he needs to give you a letter to take to PM offices (better if you go in person - then you might be able to work out a small cash payment for the extra WC paperwork, or something). I'd also ask him straight up what happens when you've exhausted all your options and you can't find anyone to treat you - do you just go to hospital and explain that your doc won't treat you anymore? This wouldn't look good for him.
Another great point by Jema....Especially the part about what happens after you've exhausted all your options. I'd ask him "Hypothetically, what if I end up in the hospital from all of this or worse" and then see what he says.....
I strongly feel you have to say these things to put it all back on him....He's put you in this situation, so he needs to understand the potential consequences.

Regards,

Ex

 
Old 09-23-2009, 02:46 PM   #15
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Re: My doctor is cutting ties after 7 years of pain management. I need advice ASAP!

Thanks Jema and Ex for your help.

My doctor is going to see me one last time on 9/30 to fill my scripts for October. He also said he is going to try and find someone for me to see.

I received a letter from his office saying they will not be able to see anyone other than for primary care services.. no future worker's comp will be allowed and there will be no exceptions. They are a smaller practice. Only 1 doctor and a handful of office help. I feel they already have too many patients and this is their way of weeding it out without losing the higher paying insurance carriers.

I will ask him to write a referral letter and request copies of my records as well. I have been making calls and the problem I keep encountering is many doctors are either not accepting new patients or if they are they won't accept new patients with w/c insurance.

I also contacted my local worker's compensation board to get assistance, but they aren't returning my calls.
They recently made a big mistake on my lawyer's request for a discogram test. They sat on it for 3 months and then filed it as a medical bill in need of payment which made no sense. Then I received another letter saying "The proposed decision in the W/C case was withdrawn as a result of an objection received by the Conciliation Bureau" So in short.. I don't think they are going to be much help.

Again, thanks for the help. I will keep you posted on my progress.

Matt

 
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