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Getting more difficult to receive routine scripts

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Posted 8/25/2018 2:39 PM (GMT -5)
I have read many posts here and see a common thread. I work a full time job & have never had illegal substances show up during UA and blood tests. I was actually on my way to complete discontinuation of scheduled meds until I sustained a terribly painful injury 5 months ago. I don't know what in the heck happened over this summer, but it is next to impossible to get triplicates in a timely manner now unless I call several days ahead. I don't want to do this as it looks like I'm asking for an early refill (which I'm not). I was advised to increase the dose as needed (which has been every day now due to the new injury), but this just uses up the scheduled meds faster. It's a catch-22.
It takes several months to get authorization to see a specialist for the injury. Meanwhile I continue to work full time but in terrible pain and paying out of pocket for gadgets that sometimes help but don't last. I'm literally down to typing with one hand at work because I can't use the other without making the pain worse.
I'm grumpy as heck and don't like it. Is this the new norm? I feel like I'm being held hostage because without the meds I can't work. If I can't work I lose medical insurance. Then what's the point?
This probably just sounds like a person who's whining, but at this point I don't know what to do.
Posted 8/25/2018 2:49 PM (GMT -5)
Hello, 1 DAT! A new law went into effect July 1 that has really made it difficult to get narcotic pain medication, even with documented need. I am sure this is a big overcorrection and at some point in the future appropriate medication will be the norm but it went from being overprescribed to underprescribed. I think you should make getting an appt with a specialist a priority. I know what you mean about being told one thing (such as get it filled with time to spare...good luck with that). I am not sure what they expect people who have to get through their pain and lead lives to do.
Posted 8/26/2018 9:22 AM (GMT -5)
1 Day, to answer your question, yes this is how things has been going for quite some time for chronic pain sufferers. Pretty sad situation for many. Are you seeing a pain mgt dr? With the dr advising you to take an additional dose, how is it written on the label? As an example, lets say your script says take 3 pills a day which is how most short acting meds are written. He could write it out take 4 pills a day & that would alleviate it looking like you are trying to fill too early. By him increasing the daily dose you will not run into issues with your insurance company either.

Just a thought, but one that should work to avoid problems.
Posted 8/30/2018 7:05 PM (GMT -5)
Darla, new laws only went into affect in some states. Nothing new involving all states.
Posted 8/31/2018 6:04 AM (GMT -5)
Oh, makes sense. Sorry for giving misinformation. I have the PM place today. I really can't understand why this has to be such a stressful thing (I mean I understand, but I don't) and I wish this was part of a team that helps me. Enjoy that lucky people in other states! Thanks M & G!
Posted 8/31/2018 9:34 AM (GMT -5)
Today's appt at the same pain place...No problem with my same RX's and no mention of having to cut back due to new laws. Next month who knows!
Posted 8/31/2018 7:43 PM (GMT -5)
After reading posts here I halfway expected something to happen. July 1 coincides with my problems getting refills. I'm in CA so generally we're lagging on a lot of restrictions. Having to wait up to 3 days for a triplicate is tough because I don't want to appear to be asking for the scripts early. Now I have to call early. The doc I see does random urine screens when I pick up the scripts but so far hasn't required a visit each time.

The real difficulty is one of the scripts is only a 15 day supply which goes fast especially with this injury. It hurts like heck and working full time just makes it worse. I do have a regular appointment coming up next week but I'm reluctant to ask for an increase even though i'm literally chasing the pain. I was so happy to be close to completely stopping it all but there's no way with a torn rotator cuff, labrum and frozen shoulder that I now have. HMOs are barbaric. I was injured over 5 months ago and still haven't seen a surgeon. A sports doc told me I'd be like this for 2 years without surgery or 9 months with ( add 6 weeks off work which I can't afford).

How do you all get through the week without wanting to put your head through a wall? Suggestions for requesting an increase without looking like I'm drug seeking would be appreciated. This thing is very painful.
Posted 9/1/2018 6:42 AM (GMT -5)
This HMO you have, why this long wait? Has your drs office called them & explained with your type of injury waiting 6 months is not feasible. I know HMO’s are horrible. I am a little confused, have you seen a surgeon already & he has made the surgery recommendation? Have you called your insurance & spoken with anyone? I would move up through the food chain in speaking with the higher ups. I wouldn’t mess with someone sitting at a desk saying this is our policy. Speak with someone over this person.

As far as how to handle the situation with your dr, there is no magic way to handle this. Be honest, be descriptive when talking about your pain. In other words don’t just say my shoulder is killing me, use words to describe the type of pain you are having. If it interferes with sleep let him know this & how much sleep you average a night. Talk about how you must be able to work to keep your insurance benefits. Honesty is the best policy. Depending on how long you have been his patient he should know you as a patient.

Keep us posted.
Posted 9/1/2018 12:35 PM (GMT -5)
My insurance pretty much stinks unless you do have a life threatening emergency in which case you'll wait many long hours in an ER but will ultimately receive decent care. In terms of injuries like mine, since I'm over 50 and even though I was a "silver" elite athlete, since I'm not well-known or connected I fall under the category of "supervised neglect". It exists. I'm proof of it. Insurance plays the odds that you"ll either get better without intervention, or in my case, if it doesn't resolve within a certain amount of time, they'll consider intervention. Meanwhile I continue to work full time because I have no alternative. I don't get better. I'm in terrible pain but I work. The cycle continues. Bottom line, my group insurance doesn't have enough surgeons to cover the population, so we are ranked and sometimes culled.
Posted 9/1/2018 12:51 PM (GMT -5)
1 day, I hope when possible you can get a different plan through your employer. Back in the late 80's we were forced onto an HMO. It was awful. The drs on the plan were the bottom of the barrel, I understand what you are saying. I am sorry that you are stuck in the insurance bureaucratic nonsense.
Posted 9/1/2018 6:44 PM (GMT -5)
If you have employer provided medical insurance, open enrollment and the ability to select a new plan generally occurs in September (now). You may pay a higher employee contribution and co-pays for a PPO medical insurance plan but you will generally have more options for care within a subscribed provider network than an HMO plan.

Hopefully you can look at the medical insurance plans provided through your employer and sign on to a plan more advantageous for you.

If you have medical insurance through the Affordable Care Act and purchase in the market exchange, you can select a new PPO abased policy in January. Silver plans offer a fairly good benefit/price ratio.

Have you had any testing to diagnosis your shoulder as a rotator cuff tear? Partial tear? Full tear? Other possible finding such as a labrum tear of the shoulder? Have you seen any physician or ancillary clinician besides your primary care physician?
Karen
Posted 9/2/2018 5:41 PM (GMT -5)
I understand not being able to afford time off from work. But if/when you have surgery. You need to follow your doctors orders. Not following them could put you in worse shape than you are now.
Posted 9/3/2018 11:34 AM (GMT -5)
I wish my employer offered a PPO but they only offer HMOs. 3 months of PT didn't really help. The rotator cuff and labrum are completely torn. I guess my insurance has a max on PT visits so now the shoulder is frozen as well. Trying the best I can to work with it but boy this hurts like heck & I have lost so much muscle along with the lack of stability and strength it's really hard to even just drive. I'm glad my job isn't like a carpenter or using a jackhammer but simple tasks like using a computer can be a challenge. I don't know how i'll get through 2 years of this.
Posted 9/3/2018 12:42 PM (GMT -5)
How long ago was this shoulder injury with rotator cuff tear and labrum tear?

Who have you seen for diagnostics? Primary care? Orthopedist? What types of imaging studies? Findings?

You mention that you have had 3 months of physical therapy (of no benefit) and that the shoulder is frozen. Do you have any treatment plan in place with a physician provider?

Do you work for a small business (under 50 employees) or larger employer? Do you live in a rural or urban area?

Can you provide a brief timeline of the shoulder injury and consultations to put your situation in perspective so that we can hopefully offer advice that will benefit you?

I am sorry that you feel so beaten down.
Karen
Posted 9/5/2018 3:23 PM (GMT -5)
I work for a municipality so we have over 1000 employees yet are offered only HMOs. This happened after the recession & got worse after the affordable care act. I'm all for healthcare for all but it had a funky side effect for government workers. I injured my shoulder over 5 months ago. It took 3 months of ineffective PT before I could get a referral to a sports doc and another month to get an MRI. I will see a surgeon soon but again the HMOs try "conservative" treatment before referrals. I'm all for conservative treatment. The last thing I want is surgery, but even my PT therapist wondered why it's taking so long to even just get a scan. It's definitely torn. I have no strength laterally (I was a body builder before this injury) and horrible pain doing things like getting dressed. I can't work out. It's getting harder to drive (a requirement for my job) and scared at the amount of down time I'm facing even if I opt for a surgical approach (or if it can even be repaired). I will see my pain doc before the surgeon and think I need a short term increase just to get through this gap period. I can't sleep, grumpy as heck. As sole breadwinner I can't really take much time off for recovery. Even with FMLA my office isn't exactly sympathetic to extended leave. Needless to say I'm pretty scared.
Posted 9/5/2018 3:36 PM (GMT -5)
Shameful. I am sorry you are in this position. You deserve better. I am sure others will have something more useful to say I just wanted to say that is inexcusable. I hope help is around the corner. It is true that things seem hopeless sometimes right before they take a turn.
Posted 9/5/2018 7:38 PM (GMT -5)
1dayatatime:
Some/many municipalities are in financial distress (owing to a collundrum of impacts on tax revenues and operating revenues) which is likely why you and your local government co-workers have been offered low cost HMO options.

There should be a way for you to file with the HMO for a review of your plan of care with regards to your shoulder. These are generally assigned to an independent arbitrator.

Kaiser is an HMO beamouth on the West Coast. Kaiser has a solid track record. Not all HMOs skimp on patient care.

Have you yet seen the sports medicine physician? Is he/she a board certified orthopedist? Or something other? Or is the sports medicine physician referral still pending?

Have you had an MRI of the shoulder? Or is this also pending?

What has been the plan of care since the conclusion of conservative physical therapy (which was of no benefit)? Who is following/managing the shoulder injury and serving as the de facto gate keeper - primary care MD? Sports medicine MD? Pain mgm MD? Other provider?

There is an optimal window of opportunity for surgical repair of a complete rotator cuff tear. I hear your
concerns regarding continued delay of a definitive plan of care.

Gravity eliminated gentle shoulder pendulum movement is one way to keep a shoulder
from tacking down and becoming frozen with loss of range of motion.

I do sincerely hope that you are able to access the care that you need.
Karen
Posted 9/5/2018 8:53 PM (GMT -5)
Seashell...I saw the sports doc about 6 weeks ago. He referred me to the surgeon and ordered the MRI. I requested a copy of it for my own records and to show to out of state family who are in the medical field. They seem to get much better care there than I get here in CA. The PT therapist said he was 99.9% sure I shredded this thing after the first evaluation and visit. The pain and loss of strength/ROM are consistent with a torn rotator cuff & labrum (sports doc said same thing). I think the MRI was just to pinpoint exactly where the tears are. What is so frustrating is the sports doc told me it would take 9 months of recovery (6 weeks off work) if I got it repaired or 2+ years if I let it freeze up and then thaw it out. I seriously can't imagine 2 years of this pain and inability to even get dressed without screaming. A friend had the surgery and didn't sugar coat the recovery. From what I've been told this is a beast to recover from. A family member opted out of the surgery and went through the horror of frozen shoulder recovery (she told me to do the surgery bc I'm still relatively young (mid 50s). All I know is I just want this pain to at least drop to a tolerable level so I'm not grumpy or screaming when I move it the wrong way. I know I'll have pain but this is just beyond where I was before the injury (went from a tolerable intermittent 4/5 to an insane constant 8/9).
I do appreciate just being able to vent on this forum since folks here know what it's like to be in constant pain. It takes a toll on a person. So I guess my big decision is do I deal with this for another 2 years or go on disability and try not to go broke in the process? I have a parent who has late stage dementia and the cost of the care is crazy (another reason not to have surgery as I need my full paycheck to cover expenses). Pretty pathetic that we have to weigh finances when deciding on injury/illness treatment.
As for Kaiser, I know they've improved their care over the past 20 years but I had a very bad incident happen with them 25 years ago where an arrogant idiot doc made a mistake and darn near killed me. Back then they were cheap and you most definitely got what you paid for. Now I still pay but can't get treated. Go figure. Anyway thank you for listening and offering your advice. It's nice to be able to get feedback like this.

Post Edited (1 day at a time) : 9/5/2018 7:57:37 PM (GMT-6)

Posted 9/12/2018 8:35 AM (GMT -5)
I am so sorry you are going through this 1 day 😞
I had a frozen shoulder a few years back. I learned a few important lessons about it:
It is going to take 9-12 months for the pain to relinquish. Now, do what feels right. I did pool therapy at
A local YMCA, Gentle motions as tolerated in warm water. If you do nothing, it is still going to take the same amount of time. It goes through stages where at the beginning it’s painful, then just frozen and finally starts to loosen up.
But, you also have two major issues with your shoulder. Labrum and rotator cuff tears. I would consult another Orthopedic sorgeon with your MRI. Go a little further for another surgeon. You definitely need a second opinion. THOSE ARE TEARS THAT CAN BE FIXED. When they are in the OR,they can move your shoulder around to break the adhesions of frozen shoulder. Does your company
Offer you short term disability? It is illegal to fire someone related to a medical claim. You should be allowed to get your job back. My boss was like that also. But you need to take care of you.

Take care. I hope your pain gets better each day. 😎
Carol
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