Then they came for me—and there was no one left to speak for me.

davidgoliath

Many times before I have stated that those in the chronic pain community if THEY DO NOTHING… THEY GET NOTHING… According to this one person’s post SILENCE in the chronic pain community is EPIDEMIC ! In this particular incident.. SILENCE IT NOT GOLDEN ! There are a lot of people – like myself – advocating for the chronic pain community…but.. without the cooperation of those in the chronic pain community.. at some point they will become discouraged and stop advocating for chronic painers… just like Doctors have stopped prescribing controls and Pharmacists have stopped filling controls. “they” are winning… because no one wants to have THEIR DOG in this fight !  BOTTOM LINE… if your are chronic painer… you need to put on your “big boy pants” and your “kick ass shoes” unless you prefer to be in uncontrollable pain and confined to a bed/chair/house due to your pain… just keep on doing NOTHING on your own behalf… because the DEA is not going to give up… a lot of their jobs depend on it…

First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out—
Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

 

This is a comment on my blog…

Comment: Sorry you have had such a hard time w/ the grievance procedure. The CMS rep told me the same, that I should receive benefits and if I don’t I need to contact my insurance company. You need to bypass the min wage rep and demand a supervisor at the bare minimum then go to CMS and do the same thing bypass/demand.

I do have an update in regards to how my grievance procedure is going (or not going) that is rather interesting in light of what you are sharing in your post. On Dec 18 I had still not heard back from BC/BS PDP regarding my grievance which was now the >30days they guaranteed.
So. I called CMS. The rep was a joke but the supervisor I talked to took down all my information and commented that she thought I had a clear case of more than one violation w/ both the insurance company and the medical center’s pharmacies. While waiting on their computer to go through its motions there was a bit of down time. I told her that I kept up w/ all the goings on w/ the prescription drug ‘epidemic’ and the resulting patient abandonment and pharmacy refusals.
I commented that they must get these complaints all the time. She told me that this was actually the FIRST complaint she had received that was against a pharmacist!!!

Keep in mind that this was a SUPERVISOR w/ CMS; and in Dec ’14 she was processing her FIRST grievance against a PHARMACIST for refusal to fill and therefor in violation of contract w/ Medicare Part D provider?!?!?!? Unreal. Almost a direct contradiction to your experience.

Interestingly enough I received a call back from BC/BS Part D rep not 2 days after filing complaint w/ CMS, coincidence? No, she left message saying it was in regards to the complaint. So ignore til it goes ‘higher up’ must be their strategy. I Spoke w/ her on Dec 23 for an hour. She continually made excuses for the pharmacies in the medical center’s network then went on to suggest that I change to a doctor closer to home!!!!!!

I then read verbatim from their Evidence of Coverage booklet in which they claim, and repeated in their booklet ‘Annual Notice of Changes’, that say and I’ll quote:

“The Evidence of Coverage is the LEGAL, detailed description of your plan benefits. It explains rights and rules you need to follow to get covered services and prescription drugs”
She told me that there were a lot of ‘problems’ and that the hospital had ‘regulations’ blah blah blah…..I then read another section…….
and I’ll quote it “The Evidence of Coverage and applicable riders attached hereto , and completed enrollment form, constitute the ENTIRE CONTRACT between the parties and as of the effective date hereof, SUPERSEDE ALL OTHER AGREEMENTS between the parties”

Seems pretty cut and dry and that is why I imagine she then asked me if I would participate in a 3 way call between her, myself, and the PIC at the pharmacy. Stonewalled by dunce PIC and when asked about the specific ‘regs’ that limited me to use of one out of seven of the medical center’s pharmacies he said he could not divulge any information!!!! Not a surprise as I have asked several times where I can find this information in writing and been denied. My guess is it doesn’t exist. After the call the rep promised to call the director of pharmacy for the medical center who set up this ingenious plan of limiting my rights that I pay a premium to receive and am being denied. But as of yet, no call back from insurance company but did receive a call from the director of pharmacy at the medical center the day before Thanksgiving. I went over all the same points of contention and received the same stonewalling towards the end of a 2o min or so conversation she asked when my next ap
t was. I
told her it was on Dec, 8. My Rx was filled that day but WITH A 2 HOUR WAIT, never had to wait more than 1 hr prior to this time. This DID coincided w/ hitting I-95 rush hour perfectly though.

To end this I cannot say how disappointed I am in being put off despite pointing out direct and seemingly in controversial proof of my rights under Medicare Part D being violated, and secondly the apathy of those patients out there who are taking it on the chin and do not fight back. We cannot wait for ‘something’. I don’t need to tell anyone here this but still, I am continually dumbfounded by all the comments on advocacy sites and comments sections following news columns and online news clips that say why isn’t someone doing something about this?!?! HELLO, STEP UP TO THE PLATE FOR CHRISAKE.

I am still in disbelief. I don’t expect much from an insurance company as I was in litigation w/ one for 4 years to get a settlement over an auto accident that their client was clearly at fault BUT over rights for the disabled, supposedly backed up by the Federal Govt? If I dont receive some satisfaction, and I am not one for big conspiracy theories, but am left w/ nothing more than the idea that there has got to be some kind of collusion going on here to shut down treatment of pain. Possibly as part of an overall reduction in spending in regards to medical care. I have witnessed this in having to fight for 7-8 other medications, most NOT controlled, that are listed in my formulary,but I have been denied coverage for. Eventually they have been approved but not w/out spending hours on the phone w/ doctors, pharmacies, insurance company myself, not to mention the paperwork the doctors must fill out.

IF anyone has any success stories about their grievance procedure I would love to hear it as at this point I am thinking I have just made myself a target and will have a harder time getting meds now than ever. I go for my next appointment and attempt to fill on Monday so hopefully all will go well. I shall give an update on this thread once I hear back from CMS,

8 Responses

  1. http://www.thepetitionsite.com/takeaction/891/682/672/, can you believe some have posted that they were afraid to sign this petition for pain care? Have read about a suicide Christmas day of a young woman that could not handle the pain and burden any longer. I agree-great post. Thank you for being the only pharmacist willing to help me in my 10 years of illness.

  2. I hope patients grow those big boy and big girls pants and put their kick boxing shoes on too! That sentence says it all. WE can NOT sit back, whine and be passive about all this. It’s not going to get better all by it’s self. We will just continuously be getting ripped off and our care will be nothing!!
    WE need to stand tall and grow our nerve so we as caregivers and patients can begin to get more patients ready to box these jerks for our PAID FOR heath care. We need to fight back against our insurance companies, pharmacies, and file complaints to CMS too. WE need to state to them in their own words what they promised us when we decided to take their plans. They need to give us what we’re paying for! We need our medications, so let’s go out fight them all for what our rights are!
    Great post Steve. I love this one!

  3. “We can easily forgive a child who is afraid of the dark; the real tragedy of life is when men are afraid of the light.” Plato

  4. I too have an active grievance through my insurance company over my inability to fill my scripts. I notified them that the pharmacy makes me have four non-control scrips per each control script. These are scripts I don’t even really need. I just throw them in a box when I get home. I told them this. They seemed fine with it. I was stunned but I am awaiting my notification of how it was handled. The 30 days are up next week. I expected the insurance company to be unhappy paying for all of these unnecessary prescriptions required to fill the ones needed. Imagine how much money they pay out for all of this. It’s insane.

    • Jammie,
      I wish you luck, but if your experience with grievances is like mine has been you will probably not receive a response at all. I have filed at least 5 grievances with my United Health Care plan d Medicare drug insurance and all of them are still “pending” and they range in time from 6 months to 6 weeks old. I filed grievances with CMS for the plans lack of response and was told that CMS does not response d to grievances unless they need additional information. I can suggest you send a copy of your grievances to Mr. Donald Levinson at Department of Health and Human services. He was the administrator of HIS a couple of years ago and his department has assisted me in the past. It is also possible to appeal your grievance up to the IRE (Independent review entity) or an ALJ judge if you follow the steps properly and you may get a binding decision.

  5. I agree and i already am confined to bed/home isolation which makes my already being depressed even worse as i am forced to work as disability doesnt pay enough to live on. And stillnstruggle while working part time from,home and on,disability . wish theyd find help,for disabled people those of us who arent lucky enough to have someone or have section 8 housing.l,instead of continuing to punish us for having something that WE didnt purposely do to ourselves. Disability is a joke they make,you fonthrough hell to get it. ie…not working while you wait for it to get approved,then when you get approved you dont even get half as you need to survive on,iworked for 25 years and dont even get 1400 a month,its a joke.

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