where can I get legitimate help with my pain medications

Discussion in 'Fibromyalgia and ME & Chronic Fatigue Syndrome' started by doxygirl, Mar 24, 2008.

  1. doxygirl

    doxygirl New Member

    Hi everyone!:)

    As some of you already know my medical ins ( prescription coverage) had been giving me a really bad time with my pain medications...

    I have been seeing a pain "SPECIALIST" for almost a year this dr has a PH degree,... and he and I click very well......

    ....he has worked very hard with me over this time to try different medications,.... and finally after all of these months I feel that I have a pain medication regimen that is as close as Iam going to get to being agreeable to me and my needs....and it has helped me a lot...

    the problem is,..... along the way my prescription coverage ( medical ins) "CIGNA" has continuously sent me letters for almost every single medication I have tried to take for more than a month....

    they send both myself and my pain specialist "these" letters stating that they are concerned with the medications Iam taking and classify their concerns as "safety" issues...

    ( I suppose they are not concerned about my "safety issues " of going into with drawls (which in worst case scenario)..... could be life threatening now are they?:(

    anyhow....my dr has backed me up fighting back to every single letter they have sent,..... but it just is like a game and Iam tired of it....I found a regimen that is working and Iam having NO problems with!!!!!!!!!!and they just have to interfere!

    They refused to refill my last prescription for Oxycontin ( oxycodone )....... when I went to pick it up at the pharmacy and found it was denied... I almost broke down right then and there....

    I am tired of this game!!!!!!!.....and just want my medications,....and without all of this nonsense!

    IMO it is clear that THE REAL PROBLEM ( as my son says ) is really a MONEY issue, they do not want to pay for these meds and really their denials are really NOT about the safety issue they claim...that is just their justification!IMHO!:)

    ( because as I mentioned if they were really concerned about my safety they would not be roadblocking me from being able to take my medications that I need and that my body depends upon at this point)

    Iam so frustrated,..... I think Iam repeating myself in this post and I apologize for that......what I need is help finding a source(s) that I can get my pain medication ( oxycodone) from at a reasonable price...

    my pharmacy wants to charge me approx 420.00 for one month supply of 120 tabs.....

    I found them as low as 120.00 for the same amount of tabs at an online pharmacy...but Iam very concerned about the legitimacy of these online companies......

    Someone here posted ( sorry I forgot who it was right now) a website than gives out "prescription discount cards" and if you google that,... many will come up....but the problem I have is this:

    I HAVE PRESCRIPTION INS...MOST PLACES SAY IF YOU HAVE INS THEY WILL NOT HELP YOU....MY INS REFUSES TO PAY FOR THE MEDICATIONS I NEED SO IMO THAT IS THE SAME AS NOT HAVING ANY INS!!!!!!!??

    So how do I get around this....there has to be a way for me to be able to get my medication without paying an arm and a leg and without all of this carp from "CIGNA"!

    PLEASE if you know of any companies that are legitimate .....or assistance programs or anything that can help me to get my medication will you post it for me?...

    I have to find another way to get my medication as I do not need this fight every time I go to get my medicine!!!!!!

    I am beginning to feel like having ins is more trouble than it is worth ......if you cannot get the medications you need why even have ins!!!!!!!

    Hugs
    Doxy

    [This Message was Edited on 03/25/2008]
  2. Janalynn

    Janalynn New Member

    Hi Doxy
    Maybe they mean if you have insurance they won't accept it - so don't tell them you have insurance.
    What mgs of Oxycontin are you taking? Have you spoken with your doctor yet? Is he willing to help at least to buy you a little time?

    I know this is NOT another stress that you need - no one does!!!!
    I so hope you get this worked out!
  3. Highlights

    Highlights New Member

    Doxy,

    I'm not sure what the answer is in this situation, however, I did want to say I think this is fast becoming a problem for all patients suffering in pain. Perhaps it would be reasonable to call a different pharmacy and just ask what the cost would be to fill your prescription because you "don't" have any insurance. I do know that there are different prices based on whether or not you have insurance.

    On the other hand, most all of the health insurance companies have become SO powerful, my personality would be to stick it to them and force them to pay for your prescription. The insurance industries want to grab our premiums and then not pay out when we need them. I would be inclined to stand my ground since your doctor is willing to fight for your right and make your Insurance company pay for your medicine.

    I have BCBS and just got a letter last week stating they will no longer pay for any Ambien CR without a letter from my doctor stating I cannot take generic Ambien. Also, got a letter a few months back stating that they will no longer pay for Celebrex....that I must use over the counter Advil, etc. Well, I can't because the over the counter Advil and others give me stomach ulcers.

    So, personally I see the Health Insurance Companies as huge, dishonest, money crazed outfits that are putting the screws to all of us in constant pain. I know you're upset and frustrated right now, understandable. I totally understand but I say "Don't let your company off the hook, especially if your doctor is willing to fight for you!"

    Keep us posted as I see this is becoming an ever increasing problem with health insurance coverage. They want to dictate the cheapest meds they will pay for, not what works best for an individual.

    Hugs,
    Nancy
  4. kbak

    kbak Member

    Hi Doxy,

    Boy my heart goes out to you.! I think because more and more people are coming down with autoimmune disorders, this is causing a big increase in claims. Like all companies their main concern is their shareholder's and profit.

    These potant meds are insanely expensive. We are the only country that has these insane drug costs. So of course the ins company doesn't want that expense.

    I think you might need to spend some time on the net looking for groups where people are ordering from pharmacies out of country. That way you can find the pharmacies that are legit and safe. I know there are many people out there doing just that.

    You might be able to even get the drug cheaper from Canada.
    I sure hope you can find some answers. Please take care.

    kbak

  5. BonnieR

    BonnieR New Member

    Hi Doxy, I have this "insurance also" and have had the same problem. But it was with ambien. I could only have 7 pills a month even though my pschy.doctor wrote my script for 30 pills a month. They say a safety issue. Now, for some strange reason since it is generic, I can get as many as I need. My doctor told me that it is not a medical reason that won't fill it but it is the cost.
    I don't see how these insurance compaines have the authority to decide what is right or wrong for a person when your doctor has prescribed what we need.
    I really don't know what the answer is for us, but I just wanted to let you know you are not alone.
    Bonnie
  6. Janalynn

    Janalynn New Member

    By the way, when I refilled my last month, the pharmacy told me that the generic form was no longer available. No wonder it's so expensive.
    I asked about the mgs you're on because you're obviously taking 4x's a day (120/month) - just wondering if your doc can tweak that at all with dose and quantity to get the cost down for you. I know you're found the perfect combo and hate to mess with that. Just a thought.
    I KNOW what a challenge it is to finally find something that works! It seems that I've gone through a year of finding something(s) that give me at least some relief.
    Don't give up - I know you won't - you're a Fighter!
    Janalynn
  7. hermitlady

    hermitlady Member

    Hi....I tried to find you last night. I replied to your post and then it disappeared. I went to chat and to chit chat. I was going to try to give you my email addy, against the rules I guess. I wish there was a way, somewhere to go so we could swap #s. Anyone have any ideas?
  8. Jana1

    Jana1 New Member

    I thought everything was going well until the dr prescribed that other drug for breakthrough pain, and that is when all this other trouble started up..I am not sure of the name...something like antique or something LOL.

    I have never had prescription coverage...so I cut down as far on oxycontin as I could and still do anything. I take 10 mg 2 times a day but have another extra one just in case I need it. Those build up in time since I dont use that third one much. I used to take 3-20 mg a day...wow the price was out the ceiling. and then the Lyrica was even more. I got off that, and am still doing somewhat ok. Not nearly as well as last year, the med bill is way far down.

    Jana1
  9. hermitlady

    hermitlady Member

    I have so many meds that have been prescribed to me, I've paid for and then been unable to tolerate. Some of them I've kept just in case someday I need to try them again. There should be a way to return them or donate them somewhere so others could use them. I've never heard of anything like this tho.

    I know it's probably an impossible thing due to FDA controls etc, but people like Doxy could benefit from someone else's discarded meds. Just ridiculous.
  10. Highlights

    Highlights New Member

    Bonnie,

    Regarding your post about your insurance company refusing to pay for your doctor's 30 day prescription for Ambien and only paying for 7; I take Relpax for migraines. A neurologist prescribes it. He writes for #30 pills.

    But do you think BlueCross BlueShield would pay? Oh no! They will only pay for 6 pills per month.

    And as I said earlier in a post, they've notified me they won't pay for Celebrex and as of last week, they are now refusing to pay for Ambien CR.

    Patients should rise up and put a stop to this. We need some kind of legislation that prevents Health Insurance Companies from dictating what medications our doctors can prescribe for us.

    This just infuriates ME! And, does anyone else's health insurance company send them a yearly print out of every single prescription that you've had filled with advice on other ways to deal with your medical problems? Yeah.....again my BlueCross BlueShield does this. It's kind of like BIG BROTHER is watching YOU!!

    I consider it an invasion of my privacy and none of their business what medications I have filled, or how often my doctor writes them.

    Sorry but I'm so steamed over this entire issue....can you tell :)??

    Nancy
  11. Toga

    Toga Member

    I used to have the same problem with BC/BS. I would get a letter and then my doctor would have to "certify" by fax that I did, indeed, need medication. They did it for everything, Pain, Sleep, Stomach, etc. pills.

    We now have Healthlink and so far so good. Except now I don't take any pain meds and I take OTC Prilosec and Ambien is now Generic.

    Two of the biggest problems in this country is Insurance Companies and Drug Companies. They are no longer in business to help people. They are in business to make money and they want more and more.

    Toga
  12. willruthie1965

    willruthie1965 New Member

    HAve you considered methadone. I hear it's not as bad as some medications as far as safety. This is a medicine you could afford on your own for less than 25 dollars a month.

    I hav heard alot of fibro patients taking it and haveing good results. Ruthie
  13. PVLady

    PVLady New Member

    This is a link for the consumer complaint form for Cigna in California. Please file a complaint immediately. By law they must respond in a certain time frame. Also, you should call the California Dept of Insurance and file a complaint. I am sure there are tons of other complaints against them.

    By becoming a "squeaky wheel", you may have your problem solved. They get away with this with so many people because they don't file formal complaints. Try to keep a copy of your complaint.


    http://apps.cignabehavioral.com/web/basicsite/consumer/customerService/MemberComplaintForm.pdf

    Check this box if this case involves an imminent and serious threat to you or the health of the patient, including but
    not limited to severe pain, the potential loss of life, limb, or major bodily function.

    If it does, please phone CIGNA
    Behavioral Health of California Customer Service at (1-800-753-0540) immediately to let them know.


    Please read the enclosed brochure about your rights and the appeal procedure. To serve you quickly, it is important that you provide
    as much of the information as possible. If you have any questions about the meaning of anything on this form, please call
    Customer Service at (1-800-753-0540).


    There are two sides to this form. Please print clearly. Complete all sections of this form.

    Member Complaint Form CIGNA Behavioral Health of California
    Customer Service
    450 N. Brand Boulevard, Suite 500
    Glendale, CA 91203
    (800) 753-0540
    CIGNA Behavioral Health
    of California

    When completed, mail this form to:
    CIGNA Behavioral Health of California
    Customer Service
    450 N. Brand Boulevard, Suite 500
    Glendale, CA 91203

    or, in an emergency, fax it to: (818) 551-2787
    00005-CAL CONTINUED ON REVERSE

    I am submitting a written expression of concern and/or dissatisfaction to CIGNA Behavioral Health of California.
    Member Information (Member complete this information)
    Patient Information (Complete only if Patient is other than member)

    Name (Last, First, Middle Initial) Member Identification No.
    Name (Last, First, Middle Initial) Relationship to Member Social Security No.
    Mailing Address (Street, City, State, Zip)
    Telephone No. (Day) (Evening)
    Name of person filing complaint (if other than member)
    Mailing Address (Street, City, State, Zip)
    Telephone No. (Day) (Evening)

    FOR INTERNAL USE ONLY
    Complaint Initial Determination
    Appeal
    The California Department of Managed Health Care is responsible for regulating health care service plans.
    If you have a grievance against your health plan, you should first telephone your health plan at 1-800-753-0540 and
    use your health plan’s grievance process before contacting the department.

    Utilizing this grievance procedure does
    not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance
    involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that
    has remained unresolved for more than 30 days, you may call the department for assistance.

    You may also be eligible
    for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial
    review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment,
    coverage decisions for treatments that are experimental or investigational in nature and payment disputes for
    emergency or urgent medical services.

    The department also has a toll-free telephone number (1-888-HMO-2219) and
    a TDD line 1-877-688-9891 for the hearing and speech impaired. The department’s Internet Web site
    http:/www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.
    You also have the right to initiate an independent medical review (IMR) of your appeal from the Department of Managed Health
    Care.

    You may apply for an independent medical review for disputed health care services that have been denied, modified, or
    delayed by the Healthplan or one of its contracting providers, based on whole or in part on a decision that the health care
    service is not Medically Necessary. You should first attempt to resolve your appeal through the Healthplan s appeal process.
    For more information regarding the IMR process please call customer service 1-800-753-0540.
    __________________________________________________________


    CIGNA Fined For Neglecting Consumer Complaints

    NEW YORK ---CIGNA Healthcare of New York, Inc. has paid the New York State Insurance Department a $150,000 fine for neglecting consumer complaints for a prolonged period of time, which is a violation of the law.

    In addition to paying the fine, CIGNA pledged to take steps that would prevent the recurrence of the customer service violations which initially prompted the Insurance Department's action, Supt. Howard Mills said.

    "The monetary penalty we levied against CIGNA is another demonstration of the Insurance Department's commitment to fighting on behalf of New York's health care consumers," said Mills. "We will not allow a company to drag its feet to the detriment of its customers."

    Under New York State Law, insurers and health maintenance organizations (HMOs) have 15 business days in which to respond to consumer complaints sent to them via the Insurance Department's Consumer Services Bureau (CSB), a statutory deadline CIGNA repeatedly failed to meet.

    The Insurance Department alleged, and CIGNA agreed as part of the stipulation, that CIGNA provided neither timely nor substantive responses to the written customer complaints that were referred to CIGNA via the Insurance Department's CSB. The Department sends hundreds of pieces of correspondence each year to CIGNA's Customer Advocacy Unit for either a response or action on CIGNA's part.

    "We insist that the insurers and HMOs regulated by the Department are responsive to customer complaints and we'll continue to monitor this situation on behalf of CIGNA's policyholders," Mills stated. 1-24-06

    © 2005 North Country Gazette

    __________________________________________________________

    [This Message was Edited on 03/25/2008]
    [This Message was Edited on 03/25/2008]
  14. loldershaw

    loldershaw New Member

    Hi Doxy

    I have had a lot of experience with the health insurance industry over the past 20+ years, and I sympathize with you. I do know from experience that if you exercise your formal appeal rights you can often get what you need with regard to medications, especially for the types of issues you are describing.

    If you have a lot of moxy, I would even suggest that you raise a really big ruckus, if after the appeal process, this keeps happening. There are a lot of situations, of course, when certain treatments/medications are not covered, and those are explained in your contract - it's hard to argue with those and if you do, you won't get anywhere. However, what you have described does not fall in that arena. I'm fairly certain that if you have the energy and patience, you can get this done. Insurance companies do not like publicity - especially about what you are describing.

    Best Regards

    Linda
  15. doxygirl

    doxygirl New Member

    Thank you so very much to everyone!

    There is so much helpful advice and I intend on using it!

    PVLady, every time I go to the website to get the complaint form,.... my computer locks up....it just completely freezes!!!....

    do they have it rigged so that going to that site ruins our hardrives? LOL.... truthfully not funny?

    My computer NEVER ever gives me this trouble..... I have tried several times and have had to completely turn off my computer UNSAFELY just to get it to unfreeze?????

    PVLady,.... I appreciate so much.... the time, effort, and trouble you have taken to post this information for me....but I have a HUGE favor to ask of you,.... and if you cannot do it PLEASE do not think twice ok?

    Could you possibly fax this form to the staples near my home?

    I can go pick it up tomorrow? I hope so much you do not think Iam over stepping my boundaries here????.... you have already done do much for me!!!!

    ......if you can... you can!!...and if you cannot, or do not want to,.... that is fine!

    the fax number to my local staples is 760-961-9885 and you already know my name,.... so I can pick it up under my real name:)

    I really dislike asking you to do this....I just have no other way to get it,... that I can think of.....

    Thank you with all my heart if you can,... or if you CANNOT do this for me........

    .......and Jam338 is right this was so kind of you....no matter how "dusty" things do get "really" almost all of the people here would do anything to help each other, YOU being one of them!:)

    Thank you again.....to everyone who has tried to help me here:)

    Hugs Doxy
    [This Message was Edited on 03/25/2008]
  16. doxygirl

    doxygirl New Member

  17. desertlass

    desertlass New Member

    I saw you message last night, but didn't have time to reply to day-- too busy in "crash" land. :(

    I went to the Purdue site, and it seems they do have some sort of Patient Assistant Program. I think it is mainly for people who don't have insurance at all, but it looked like they also had something for people like you who are falling through the cracks.

    This is just crazy and unacceptable what is happening. I really think it is next door to fraud.

    So what if one brand of pill is expensive. Some people have to take several of different cheaper ones, but if added together might be the same amount.

    It's just all arbitrary because of the type of drug it is.

    I think there is a "Patient Bill of Rights" concerning pain management, but I can't remember now where I read it.

    I could just go on a rant, but in the meantime, just know that I'm with ya!

    Lisette
  18. doxygirl

    doxygirl New Member

    Thank you for checking that out for me....you are a doll for going to the trouble for me!

    It is sad how most of the drug assistance programs are for people who have NO insurance BUT what really is the difference?

    I mean we pay over a thousand dollars a month to have ins and then they refuse to pay....that thousand dollars would buy a lot of medications !!!!!!!!

    In a sense it is worse for me than someone who has no ins at least there is places that WILL help them ....for me I cannot get my ins to pay for it and I also cannot get the drug assistance programs to help me either.....

    Catch 22 that is for sure!

    But you are right there is a patients bill of rights and my pain dr is very well educated and know them like the back of his hand....in fact he has faught for some of these rights for those of us with IP!

    I know he is going to help me.....but in the meantime it is taking a lof of energy that I just do not have to fight.....and I get so sick of fighting not only this but EVERYTHING!

    I could open an entire can of worms here but I better not LOL :).....

    Iam just tired of paying for things and getting screwed over when I go to collect services for what I have coming because I paid for it!

    "Oh my"...what can I say ......? I will let everyone know what happens with this I promise!


    But I did want to say again thank you for posting to me and for caring!

    Hugs
    Doxy
  19. PVLady

    PVLady New Member

    Yes, I will fax it tomorrow, no problem....I think I know the problem - this is a Adobe PDF file. You need to download the free Adobe software in order to open it, or check your computer if you have Adobe.

    You might see the Adobe software on the Cigna main site.

    I will fax the info anyway - I have your email but am such a airhead, I forgot your last name. Can you email me your last name again, or I can try to send just to your first name.

    thanks

    jam338 - thank you - I have known Doxy for several years here. I see you are in Sacramento, and my same age!!

    I will be driving through Sacramento in July - have to go to Lake Tahoe for meeting. Maybe we can have coffee. It will probably be hot in July. Our grandkids live in Sacramento area.
    [This Message was Edited on 03/25/2008]
  20. doxygirl

    doxygirl New Member

    I do have adobe ..but it seems like I need to do an update....Iam trying to figure it out right now.....but I did not want to mess up my computer as it seems to be causing it to freeze up so bad!

    But I do thank you so much...and really,.... if it is any trouble "at all" PLEASE don't do it....I do not want to add any stress at all to your day....
    ok?

    One million thanks XO
    Doxy