New insurance refusing to pay for meds!

Discussion in 'Fibromyalgia Main Forum' started by Bambi, Aug 20, 2005.

  1. Bambi

    Bambi New Member

    They just changed insurance where my husband works, seems to happen every or every other August. We've always gone for the PPO's and this is supposed to be one but the card say HMO. They say it is "like" a PPO but has the HMO title. I can't make any sense of that!

    Anyway, the filled the pain meds for us this month and then sent a letter saying they will not do it again unless our doctor calls them and explains on what basis he is prescribing the meds for our
    conditions. My husband has Diabetic neuropathy, a congenital back problem with Arthritis and bone spurs that is very painful as well as terrible knees. He had surgery done on one knee and it causes him more pain than the other one.
    Surgery for his back is very iffy and can
    either work (less than 50% chance) OR can leave him in severe pain that even the most potent narcotics will not treat.

    I have been on the same meds for at least 8 years and on this dose of everything since 2003 without having to adjust the
    amount of medication. No other insurance has refused or questioned our prescriptions. Our doctor is a pain specialist and has no complaints or judgements against him and hasn't in 40
    years probably.

    Needless to say I am really scared and worried, not only that I may have to go off the medication without anything to replace it but more so of returning to the HELL that was my so called life before the meds. I was in 24/7 agony for
    several years, inflated pulse and blood
    pressure, skin erruptions, panic attacks,
    insomnia, terrible knock me to the floor
    muscle spasms. I was very suicidal by the time I found the doctor that started me on the pain meds and when she moved referred me to my pain doctor.

    I do everything to the letter with my meds and many self help things as well;
    exercise, self hypnosis, heat, ice packs,
    linaments, massage, Epsom salts and Peroxide baths, vitamins, OLE, Fish Oil,
    Flaxseed Oil, Vitamin E, B Complex..and it has all, with the medication, made my
    life bearable.

    I can do my chores at home from laundry to my pets to cooking again after years of being too fogged and in too much pain to do anything. I am able to get out and go to a mall or to a family dinner which I couldn't before. I am teaching myself to draw and paint. I HAVE a life again where I didn't for so long, and was suicidal before I finally got help.

    This insurance place is huge. I called the recordings they have on various conditions and for Fibromyalgia you would
    not believe what they say. First off they call it Fibromyal-geea, like it was some
    new word. They claim we have inflamation
    and that's is mostly in YOUNG PEOPLE but
    also in some older ones. Just backwards of what is true. They advocate exercise
    and rest. If that doesn't help then they
    say to do the usual massage and a couple of other things. Then they say as a last
    resort some medications help like a muscle relaxer and antidepressants.

    Well antidepressants DO help some people I know, but they did NOTHING for my pain
    and I'm NOT depressed. Or wasn't until this. The off label use of the anti seizure meds didn't do a thing for me, nor did Chiro, Accupuncture, PT, TENS (I
    have an expensive paid for TENS machine
    sitting here collecting dust!) or any of the other things that help some but didn't me!! I HAVE tried everything, kept
    what DOES work for me and stopped the rest.

    Noone wakes up and says "Gee I think I want to take opiods the rest of my life"and neither did I. I was apprehensive at first. But I don't get any high, don't feel groggy the next day
    and ONLY feel relief of my pain and as a
    result able to function again! I do take
    Trazadone but it only works for sleep for me and does NOTHING toward my pain. The
    muscle spasms were as bad for me as the pain and every doctor who saw me having
    them said they'd never seen anything like
    them..they are that bad! So the muscle relaxer has been a God send also.

    My doctor will have to appeal this decision and I think we'll have to also,
    but I don't understand the first thing
    about it. I think they only give you five
    days to put in an appeal. If I had a printer and time I could find piles of
    information on how using pain meds is necessary for some FM patients with moderate to like mine, severe pain. I could get someone from the American Association of Pain Medicine to send me some brochures and info to give them, but there isn't time. Besides, they KNOW what all I've tried and that this works for me, it's all in my records!!

    They only use as authority for their judgements agencies that do NOT agree with opiods for FM pain. Of course, it saves them thousands of dollars not to have to pay for them! I guess they'd rather see patients like me go back to hunting up Kavorkians than to live a relatively normal life??!! It is beyond
    unfair and is very frightening and depressing to think of how my life will go backwards to NO life if they succeed in not paying. The pharmacies here won't
    let you pay cash, if the insurance won't
    pay for something, they won't fill it!!
  2. naturebaby

    naturebaby New Member

    I wish I had a good suggestion for you......you need an advocate of some kind. Anyone out there with insurance comopany experience that could help?