Insurance change - Pain Management Message Board

pmtest · 10-13-2009, 10:18 PM

Hello,

Hope everyone is doing well tonight. I got my benefit package in the mail today and guess what...my pm dr doesnt accept either of my options. The current one I have doesnt either, but they do have out of network benefits but my two choices do not. What do I do? I am so livid right now, just when I felt as thought my pm trust me and we have a good relationship, the rug is pulled our from under me.

I can not afford to pay straight out every month for my visits. I know I have read a few places on here about people having to change (not because of dismissal) but I just do not see going to another pm and receiving the same meds I am on straight out. Do you think my current pm would help me, meaning refer me to another one and request that I continue on my same meds. Ugh

Do you think maybe my insurance will allow me to continue there considering I am already established...Could my dr get involved and make that happen??

I just get so frustrated with insurance period and now my employer has only made matters worse. What to do...what to do...

cat_100 · 10-13-2009, 10:50 PM

I would try showing your current PM doc your choices, and ask him/her to refer you to one of them, and I would ask him/her to write a letter of introduction that you can show to your new doc.

Cat

tiggertoo2174 · 10-14-2009, 04:59 AM

Call your PM Dr. and ask what they would charge - cash. Make sure they understand that you will NOT expect any insurance to be filed - strictly a cash transaction. Just insurance processing costs Dr's a lot, if they know that they won't have to even bother with it, the number they quote you may be much less than what you expect, especially if monthly appts are only for prescriptions. If you are receiving other treatments it would be a different issue.

You could also ask for a referral to a PM doc that takes your insurance and request a letter from your current Dr. saying you are doing well with 'x' treatments and are only changing because being forced to by insurance.

If you like the current PM doc I would try to do whatever necessary to negotiate with them to stay there. You may be able to work out something where you only have to see the DR. every other month or something, and either get scripts for 2 months at a time or do a 'call and pickup' type scenario where you call the nurse and pick up the scripts on the appropriate day rather than having an appt. every month. If things are relatively stable the Dr. may agree if you explain you now have to pay cash due to insurance changes.

The only way to know for sure is to ask. You might even want to make an appt. to talk to the business manager for the practice in person. That is likely the person, other than the Dr. who will have the authority to make these kind of decisions and asking for an appt will show you are serious, and give the person the feeling that you understand that he/she is a busy profressional - the old 'you get more flies with sugar' bit, but it usually helps.

Tigg.

Executor · 10-14-2009, 09:16 AM

Quote:

Originally Posted by tiggertoo2174

If you like the current PM doc I would try to do whatever necessary to negotiate with them to stay there. You may be able to work out something where you only have to see the DR. every other month or something, and either get scripts for 2 months at a time or do a 'call and pickup' type scenario where you call the nurse and pick up the scripts on the appropriate day rather than having an appt. every month. If things are relatively stable the Dr. may agree if you explain you now have to pay cash due to insurance changes.

I agree with Tigg....I would do all I could to stay where I am, assuming I was happy with how things were going. Situations like this are the Doc's call. It's very plausible that he may work with you. I would try to butter him up a bit by saying things like "I really like you Doc and your practice, and I really don't to leave....I'm really stressed about all of this...Can you help me find a way to stay...I feel attached to this place"....Something like that. Be direct and flattering.

However, if you can't stay, I think finding a new PM Doc won't be all that difficult because you're not on big time meds. As a general rule, the more meds one is on, and the more powerful, the more likely a transition to another practice would be tough. In fact, those on very high levels / qtys are often forced to make major changes because many Docs aren't as liberal.

Take care, and I'm sorry you're having to go through all of this. When it rains it pours. I've been there a number of times and it's no fun!

Regards,

Ex

pmtest · 10-15-2009, 09:38 PM

Quote:

Originally Posted by Executor

I agree with Tigg....I would do all I could to stay where I am, assuming I was happy with how things were going. Situations like this are the Doc's call. It's very plausible that he may work with you. I would try to butter him up a bit by saying things like "I really like you Doc and your practice, and I really don't to leave....I'm really stressed about all of this...Can you help me find a way to stay...I feel attached to this place"....Something like that. Be direct and flattering.

Take care, and I'm sorry you're having to go through all of this. When it rains it pours. I've been there a number of times and it's no fun!

Regards,

Ex

Thanks for the reply. Above where you say, its the doc call, what do you mean? Do you mean he can decide to accept my insurance or not? Or you mean whether to keep me on as a patient if I pay cash?

Also, when I spoke to the office manager on Tuesday about the cost of my drug test, I feel like me and her hit it off. She even made the comment, "I know you would pay it if you owed us something," or something like that. With her saying that, I feel like she would work with me anyway she could.

You are right, it seems to be raining a lot on me lately. But I will get through it. Somehow, it seems to always work out, hopefully it will this time too