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You won't believe this!

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  • You won't believe this!

    I went to my uro this week and he asked me about my pain pills - he gives me vicodin 30 at a time and they usually last about 20 days or so. Anyway, he had received a letter from my insurance company regarding my "drug use"! So...he wants to drop to 20 at a time and only once a month. He is trying marcaine instills for pain as well - which if it works is fine - but it just gripes me that my insurance company is dictating the kind of care I get. I always use the same pharmacy and he is the only doc I get pain meds from - the insurance company should be able to see that. AND the fact that I make 30 pills last at least 20 days and sometimes longer. Wouldn't someone who was becoming an addict be taking more than that??? GRRRRRR! Well, thanks for listening to me vent. I am thinking about getting the pills filled and telling the pharmacy not to run it through my insurance and just pay full price. Has anyone done this? Oh well...
    Live life to the fullest day to day. The best way to eat an elephant is one bite at a time!

    DX: IC - November 2002 after hysterectomy
    Interstim implanted March 2006 - died May 2011
    Interstim replacement June 2011
    Meds: Pain meds, muscle relaxer, cystex, and marcaine bladder instills as needed.
    Docs: Pain management doc, urologist, family practice

  • #2
    Have you contacted your insurance company about this? I wonder if they even have accurate information about IC and the pain that is involved for some patients.

    Diagnosed August 2001

    Current IC meds: Elmiron (since 2001), Levaquin (one pill after intercourse to prevent UTIs), Effexor (for depression & anxiety)

    Past IC meds: Amitriptyline (Elavil), Hydroxyzine (Vistaril), Detrol LA, Lexapro (for depression & anxiety, but also helped my IC) (They all helped, but I was able to discontinue them.)

    I've been virtually symptom free and able to eat & drink whatever I'd like for about 8 years now.


    “We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms -- to choose one's attitude in any given set of circumstances, to choose one's own way.” ~ Viktor Frankl

    “You cannot control what happens to you, but you can control your attitude toward what happens to you, and in that, you will be mastering change rather than allowing it to master you.” ~ Brian Tracy


    • #3
      You and your physician both need to lean on your insurance company. I get really angry when insurance companies try to practice medicine!

      Stay safe

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      I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.

      Anyone who says something is foolproof hasn't met a determined fool


      • #4
        I agree, the insurance company has no business determing how much pain meds you need.
        One day at a time


        • #5
          You definately don't sound like an addict to me! lmao How dare they do that to you! How much is vicodin if you pay full price? Do it if it isn't going to send you into financial problems. I think it's worth it to not feel pain. Nobody understands the pain involved with IC and related disorders. It's one of the most disturbing, painful, and uncomfortable problems I've ever had. I'd take something else in a heartbeat, if it meant I would pee normally like everybody else for the rest of my life. How can they tell you what meds. to take? It's so annoying, isn't it? I"m sorry. Well, call your insurance company. See what you can do. If that doesn't work try buying them full price like you said. If that gets to be too much, then maybe something else will help with your pain. Hopefully the insurance won't take that away or put a ridiculous limit on how many you get of that, too. If I were you, I'd bother the insurance company about it for a while first. It's just not fair!!!!! Well, hang in there and good luck.
          "Life is 10% what happens to you and 90% how you react to it"

          Read my story at:


          • #6
            I'd start off by reaming the insurance company....then, I'd pay out of pocket for the vicodin. It's an inexpensive drug and not worth your insurance company ruining your future over
            Courage does not always roar. Sometimes, it is the quiet voice at the end of the day saying, "I will try again tomorrow".


            • #7
              Yes. I agree. I would just pay for the prescription out of pocket and let your Uro. know that you need the usual 30 pills every 20 days. It is awful what these people do to us. The pain is bad enough and then to add the stress of pain is a joke. And very sad. frown

              "Don't quit when the tide is lowest, For it's just about to turn; Don't quit over doubts and questions, For there's something you may learn."


              • #8
                WOW!!! Who is your insurance carrier?? I think your dr., needs to step in and explain about the disease you have. Just a thought. I hope it isn't BC/BS.
                People may not remember exactly what "you did, or what you said, but- they will always remember how you made them feel"


                • #9
                  That is very unfortunate! I think I would just pay out of pocket - find out how much it is. But in the meantime, definitely complain to the insurance co. and let your doc know how this is effecting you! So sorry that happened.


                  • #10
                    I agree with the gals, I would pay out of pocket, but certainly let the insurance company know how I felt. Good luck and keep us posted, Iris. hi
                    Today and every day you are loved, so don't be anxious about tomorrow, God will take care of you tomorrow; Live one day at a time.


                    • #11
                      I agree with everyone here. So very sorry this has happened to you momw/ic ! It is not right at all. We do not need this kind of stress in are lives with ic too.
                      Sue C.~
                      [email protected]


                      • #12
                        I am so sorry you are having such a time of it! I am getting so sick of the ins. companies, we pay for their services, and they work for us! Now, they just need to remember that!!! I would also probably pay out of pocket, as the generic is inexpensive, but I would also let the ins. company know about ic, and my feelings on it, and I would ask my Dr. to inform them of the details of ic...I hate to be rude, but I sometimes wish that those who judge and condemn when we are in pain and just trying to live would have some ic just for 1 hour, then they would understand!!! And I would not wish this ic on anyone! Take Care, and good luck to you,
                        Always try to do the right thing; it will astonish some people and gratify the rest- Mark Twain

                        DX: IC-2003, Systemic Lupus w/secondary Sjogren's-2009, Total Hysterectomy with BSO-2005, IBS-forever it seems, Renal Tubular Acidosis, Vitamin D deficiency-2008, Vulvar Vestibulitis-2002, Pudendal Neuralgia-2008
                        I also try and manage depression/anxiety, Migraines, Too many kidney stones to count-starting in 1991 to the present
                        I had my 1st urethral surgery at age 4, have had urethral syndrome from then on.
                        Failed treatments: Elmiron both instilled and oral caused severe increase in liver enzymes
                        Elavil and Ditropan-severe bladder retention
                        Currently on pain mgmt, lidocaine gel topically also gives some relief after initial 2-4 min burning when applied.
                        Prior treatment included pelvic floor therapy and TENS unit, both of which I still do as needed.


                        • #13
                          I find it very, very odd that any insurance company would interfere with a patient taking very inexpensive (relatively) generic drugs.

                          These are the very drugs they WANT us taking and not the super expensive ($1000/month was what my Oxycontin used to cost; my Duragesic (fentanyl) patches are $57 each. Times ten a month...

                          You get my point. Even 60 10/650 Perocet generics would be less than fifty bucks period. There are so many generic hydrocodone/acetaminophen (Vicodin, Lorcet, Lortab) or oxycodone/acetaminophen (oxycodone). These painkillers are decades old and very inexpensive.

                          My guess is that the "letters" are not from the insurance company at all but from an outside auditor. I saw several such letters in my chart with my first pain doc. He totally ignored them and kept increasing my dosage/quantity as needed until I was taking...

                          Oxycontin 40mg 2 x tid = 180 a month
                          Oxycodone (single agent; i.e. no Tylenol) 1 to 3 q 3-4 hrs for a total of 360 a month. Plus Xanax and ultimately Valium.

                          These auditor letters, in my case, said something like, "These medications are not generally to be prescribed for more than three months..." blah blah blah.

                          And no, your insurance company IS not entitled to practice medicine without a license. The Federal law that covers most healthcare plans from lawsuits (ERISA) has been pierced by clever lawyers in Illinois (and other states) because they WERE practicing medicine and NOT acting as a healthplan.

                          This sounds like what some of the insurance companies are doing in some of these posts. Especially the last one.

                          First of all, "addiction" is a judgment call. If you haven't been arrested and haven't told your doc "I'm an addict" how can they prove it? The quantities are laughable. I take so much more than that!

                          Twenty or thirty a month? I would be totally bedridden and useless to my wife and child--more useless than I am now.

                          So my advice is: find another doctor who really understands IC or chronic pain.

                          A very helpful tip is Dr. Robert Moldwin's book on IC (look up by author name on Amazon, tho' I got mine at Border's). Get it and take it with you. Show the doc the section on treating chronic pain. Bring stuff from this website. Material from this website helped me to get Social Security disability.

                          Arm yourself with info. It can convert an unsympathetic pain doc into a sympathetic one if you have documentation rather than just saying, "I'm in pain; need pills."

                          In my case, since my iron clad, irrefutable diagnosis of IC (a "middle of the road, average case" was how my uro at the time put it) I've had little trouble getting narcotics. Dealing with some of the doctor's staffs and doctor's personalities (or lack thereof) has been a greater challenge.

                          As for the poster who insurance company called her an "addict" if they put that in writing, that's actionable. If they have no proof and they have publicly called you an addict they have libelled you.

                          Ask for your chart and read everything in it. If such letters calling you an addict exist, get copies and tell the insurance company that

                          "I am considering filign a complaint against you for practicing medicine without a license. My decision will be heavily influenced by the presence or lack of interference in my treatment regimen."

                          That way you've made no threats, blackmailed no one, you've just laid it on the line: Quit jerking me around or this is gonna be one helluva fight!

                          I had to do this same thing with a savage jerk of a pain doc who actually threatened (and I would state this under oath) to write phony letters to Social Security to get my claim denied if I didn't pay for a "visit" that consisted of his calling me a liar and accusing me of attempting to defraud the government. Had there been a witness other than my three year old, I would have sued for slander.

                          Don't take crap from people because they have an alphabet soup of letters behind their names.
                          You have rights! Exercise them!

                          Finally, the woman whose gyno no longer "deals with insurance companies." that's uttterly cruel. To take already sick patients, or heavily pregnant patients (esp. if complications exist) and make these sick people deal with the insurance nightmare when, for a few pennies per dollar, she can hire a professional service to do it for her.

                          That's nothing more than greed and laziness in my opinion. If your a patient of this doctor, she's getting you to do her work. Find a doctor who cares about patients and not greedily grasping a few pennies off the backs of sick people.

                          And you'd better find another gyno quick, 'cause this one is going out of business real quick with that kind of policy. I can understand not wishign to deal with certain companies, but blanketly refusing to do it? Greedy, greedy, greedy.


                          • #14
                            Thanks for your posts. The story continues to unfold...On friday we received a letter from Aetna saying that effective saturday at midnight out group health insurance was being terminated. As it turns out our agent for our group had their attorney file an injunction so that nothing can be terminated until a judge hears the case. The court date is Feb. 12 and at that time it will be up to a judge if our group gets terminated or not. Aetna is not giving any reason for the termination but it will all come out in court I'm sure. It just seems fishy to me that one week they send out letters about my drug use, the next week they decide not to cover my heparin and marcaine for my at home bladder instills and then the next week they terminate. There are several hundred of us in the group and many of us will be in a bad way if this judge lets the company terminate! banghead

                            It just never seems to end...
                            Live life to the fullest day to day. The best way to eat an elephant is one bite at a time!

                            DX: IC - November 2002 after hysterectomy
                            Interstim implanted March 2006 - died May 2011
                            Interstim replacement June 2011
                            Meds: Pain meds, muscle relaxer, cystex, and marcaine bladder instills as needed.
                            Docs: Pain management doc, urologist, family practice


                            • #15
                              I can not believe the nerve of this insurance company.
                              If it comes down to you paying for the medication yourself look into Flexible Spending. You can pay for it with pre tax dollars which would save you some money.