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Respected Contributor
Posts: 3,930
Registered: ‎06-15-2014

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER

So sorry for your pain. I pay $700 monthly for marijuana and take 2 naproxen’s Two times a day. I still have pain but it is much more manageable.

 

Honored Contributor
Posts: 31,023
Registered: ‎05-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER

I work in healthcare and with insurers and I do know that the Fentanyl patch is not covered by most, if not all insurers.  When it comes to insurers, you can never say ALL because they have their own clinical guidelines.  It's easy to abuse the patches and there are many other ways to control chronic pain.  I have not ever encountered an insurer that does not cover oxycodone for short term use.  I took it myself a year ago after my knee replacement surgery.  My sister took it recently for a week or so after foot surgery.  I wonder if that broker was confusing oxycodone with oxycontin.  They are not the same thing and most insurers won't cover that now.  I think people (like myself) who suffer with chronic pain that is not alleviated by OTC meds should see Pain Specialists.  We shouldn't rely on anyone other than a Pain Specialists because there are many drugs and combinations of drugs available.  As my Pain specialist told me a while ago, there is no reason for anyone to suffer with and just accept pain.  

Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@missy1 wrote:

How does this person who is not a Dr. ,get these for his patients? Is the pharmacy out of the equation and the patients gets them at their visit?

If not, they having to be working under a Dr.

All ages can be addicted on these.

 


He is certified to prescribe prescriptions and is under a medical doctor which makes it perfectly legal.  He is extremely careful, there are pill counts and urine tests and no one walks out with a script in hand.  He submits them electronically straight to the pharmacies.  No hanky panky there.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@1MrsT wrote:

@patofl wrote:

@1MrsT wrote:

@Lindsays Grandma I am so sorry that you’re suffering so, and that there are no easy answers for you or the others dealing with chronic pain. It’s tragic.

 

My DH has been diagnosed with spondylosis which causes severe sciatica pain. He’s ruled out risky, unproven surgery, and he’s never wanted to do pain medication...so his doctor has him on Gabapentin at max dose, he gets spinal shots every 4 months, he does Thai Fusion massages (assisted stretching with massage), yoga, daily inversion on his Teeters, medical marijuana, and we’ve just recently upgraded him from the original Quell to the new Quell 2.0.

 

We’re trying everything to help him deal with the chronic pain he lives with. There are times when he says he doesn’t know if he can face another 20 years of this pain...but our hope is that at some point, a surgery or stem cell or something will be found to be effective which can help him and others like him. Until then, the good fight continues.

 

I’ll add you to my prayer list. ❤️


If your husband is in this much pain he should have the surgery. He has nothing to lose and everything to gain.The vast majority of these surgeries are completely successful.


Based on my research, fusing two vertebrae together eventually causes problems with the vertebrae above and below the fusion. They were meant to allow twisting and turning and when you hinder that movement, it stresses the connecting ones. And then like falling dominoes, you have new problems. 

 

Originally this surgery was for people who had suffered catastrophic injuries, who truly had nothing to lose. Then some enterprising surgeon began doing it for older, well insured patients (apparently it’s quite common in parts of FL), because aching backs and old age tend to go hand in hand. The end result was even more pain for these patients  to deal with.

 

Luckily, my husband was referred to a spinal surgeon who was honest with him. He told him the only surgery that MIGHT help him, also came with high risks of things like infection, and a good chance of making things worse. The success rate wasn’t very high...which tied into what I was finding in my search for a solution.

 

Not all surgeries work. My aunt has had THREE spinal surgeries, in the hope that each one would be the one to help her. I know surgery can help a lot of people, unfortunately not everyone.


My first back surgery was a fusion, lots of pain, it wasn't healing.  New MD for second surgery, put in ten screws.  Months later sciatica pain started coming back MD decided to remove the screws, is there any wonder my back hurts and is a mess?  I know they are there to help people but sometimes what the MD thinks is best turns out to be the worst.  You are fortunate to have a doctor who is honest, that in itself will give you pause regarding surgery.  I hope your husband finds relief. Heart

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@patbz wrote:

@Lindsays Grandma:  DH has a medical card and also takes a controlled substance.  Don't ever tell your MD that you are taking MJ or they will cut off your pain meds; just saying...


Patbz, believe me I know all about that.  I had a card which expired in May of 2017 but never used it.  First of all while taking a controlled substance , using marijuana could cause an overdose, very dangerous thing to do.  I am going to renew the card to prepare for getting off the pills and patch.  Incidentally, the pain clinic does urine testing periodically and you are history if they find MJ in your system.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@software wrote:

These posts break my heart.

I don't have chronic pain, but I do know pain.

And I know what I experience now will only get worse.

 

Regarding spinal surgery, it may fix the immediate situation but will cause other problems and won't stop the aging of the bones and any disease progression.   And our bodies are not as resilient in our 60s & 70s as it is in our 20s.

 

For a young person, yes the surgery will improve their life.

 

After I lost my kidney, I'm sitting in my hospital room, post-op, waiting for my morphine pump.

Nope, no pump.   Not even morphine!    I complained about being there so much they finally let me go home the next day.   I can hurt in my own bed!

 

Blue Cross already announced here they will no longer cover opiod prescriptions.   Fortunately, opiods are some of the cheapest drugs available.   But in your case, not sure I would risk changing plans.

 

I'm so sorry @Lindsays Grandma

You shouldn't have to live like that in this country in the 21st century!


Thank you so much, words like yours mean a great deal to me.  My Plan D is with Blue Cross Blue Shield Arizona and I called them today asking if any changes have been made for 2019.  I was told everything is the same, and if a change had been made I would have been notified by mail.  I hope and pray I don't get any surprises in January.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@chrystaltree wrote:

I work in healthcare and with insurers and I do know that the Fentanyl patch is not covered by most, if not all insurers.  When it comes to insurers, you can never say ALL because they have their own clinical guidelines.  It's easy to abuse the patches and there are many other ways to control chronic pain.  I have not ever encountered an insurer that does not cover oxycodone for short term use.  I took it myself a year ago after my knee replacement surgery.  My sister took it recently for a week or so after foot surgery.  I wonder if that broker was confusing oxycodone with oxycontin.  They are not the same thing and most insurers won't cover that now.  I think people (like myself) who suffer with chronic pain that is not alleviated by OTC meds should see Pain Specialists.  We shouldn't rely on anyone other than a Pain Specialists because there are many drugs and combinations of drugs available.  As my Pain specialist told me a while ago, there is no reason for anyone to suffer with and just accept pain.  


Interesting you should bring that up...I went around and around with the broker because he kept mentioning oxycontin.  I told him no, I am fully aware of that drug and mine is oxycodone.  He checked again and came back with the same answer.  The clinic I go to are pain specialists, that is what they do and many of them now will not prescribe the dosage I am on.  They have lowered the dosage for all their patients.  Near the end of last year all pain specialists began to lower everyone's medication, including mine per instructions from the DEA, and now it is to the point where thousands of people are hurting and no one seems to care.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@Carmie wrote:

@missy1 wrote:

How does this person who is not a Dr. ,get these for his patients? Is the pharmacy out of the equation and the patients gets them at their visit?

If not, they having to be working under a Dr.

All ages can be addicted on these.

 


The person prescribing I think,  is a physicians assistant.  They can prescribe RX, but they must be monitored and be under the direct supervision of a physician.  This person is not.


I apologize if I did not mention that, yes, he is under the supervision of a medical doctor.  When he opened the clinic he did so with partners, one being a medical doctor.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam
Super Contributor
Posts: 475
Registered: ‎10-05-2011

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER

@Lindsays Grandma. . . . First I must say I am so sorry for you for your pain. I also suffer chronic pain due to fibromyalgia and both degenerative disc and degenerative joint disease throughout my spine, which has resulted in permanent nerve damage in both lower limbs and right arm and hand. I understand the importance of pain control in someone’s life.

 

I have been seeing a pain management doctor since around 2004. She is absolutely wonderful. She does injections which truly deliver relief and knows how best to medically manage pain. When I (finally, after 18 months) talked my husband into switching from his pain doc to my pain doc, she did more for him in three months than his doctor did for him in five years. The injections he received were the first ever that helped him. Also, narcotic pain meds do not agree with my husband at all, and she was able to easily switch him to Tramadal and he is doing so much better.

 

@Lindsays Grandma . . . . It was my pain doc who suggested I try Medical Marijuana and she set me up with the appointment to see another doc within the practice. That is the way it is done in NJ, or can be done. However, I no longer take OxyContin, Fentanyl patch, Savella, anything for sleep and my Celebrex and Oxycodone are at half of what I used to take. And the bottom line is I feel so much better.

 

To the poster that suggested that the OP was addicted . . . . maybe not. Physically dependent? Most likely. When you take a narcotic pain med for an extended period of time you will become physically dependent but that is certainly not the same thing as addicted. There is a difference. 

 

@Lindsays Grandma . . . Good Luck with your meds, which ever way you go and whatever happens. You will be in my thoughts and prayers.

 

 

Hugs . . . Beth 

Life is tough, but I am tougher!!
Esteemed Contributor
Posts: 6,672
Registered: ‎03-10-2010

Re: WHAT HEALTH INSURANCE COMPANIES WON'T COVER


@IMW wrote:

So sorry for your pain. I pay $700 monthly for marijuana and take 2 naproxen’s Two times a day. I still have pain but it is much more manageable.

 


I remember a couple of years ago there were some members who were using marijuana...sadly they are no longer here and I miss them, but that is another story.  Lozenges were mentioned and were claimed to be very helpful in reducing pain.  Is that what you use?  Are you able to give me an idea of what you use?  $700 monthly is outrageous and no way can I afford that.  If you would rather discuss this privately I would be more than happy to give you my e-mail address should you care to go that route.  By the way, what is naproxen?  People just don't understand that pain medication will not take away strong pain, it relieves it, and without it, well than it becomes a situation of I would rather die than live this way.

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam