Posted 1/23/2015 10:48 PM (GMT -6)
I can see why such emphasis on the contract would be worrisome, but it may be that they do offer other avenues, it's just that they're not worried about federal regulations for those, so they may not make such a big deal. But I'd definitely suggest talking on the first visit.
Anecdote: I was getting poor pain control, so my first PM place wanted to put me on a stronger narcotic regimen, even though I had a nerve block scheduled a couple weeks away. I didn't want to switch because, like you, I've had weird reactions to narcotics and I could stand a couple more weeks on what I was taking. They really wanted me to try the higher dose, but reluctantly agreed to keep it the same.
Long story short, my wife went in without me to pick up the prescriptions that we thought were a repeat of my old ones.
Nope. Oops. They were the stronger narcotics the doctor had been recommending. My wife said there was a mistake, but the lady behind the counter insisted the prescriptions were right and after a bit of back-and-forth, she told my wife that it was either those prescriptions or nothing.
My wife, bless her heart, said it would be nothing then, and put the prescriptions back on the counter. Then she said she would mention to everyone that I wanted less narcotics, but my PM place insisted I take more.
After a staredown, the bluff worked. The lady behind the counter went and got the nurse, who got the doctor, who wrote new prescriptions for the smaller amount I was already taking. They got the idea that I wanted to be very careful when tinkering around with doses.
The point is, it may take a bit of "training," but you might be able to get a PM place to understand your unique needs.
Age 55 male, incurable adenocarcinoma (cancer) of the right lung, stage IV. Rare ALK+ mutation. Diagnosed July 2014, average life expectancy 20.3 months. Never-smoker, no risk factors, currently in palliative care for chronic pain.