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Regular Member

Date Joined Nov 2010
Total Posts : 108
   Posted 12/19/2017 5:06 PM (GMT -6)   
LONG post warning. I have used meds to monitor chronic pain for over 20 years and work as RN. I was injured in a car wreck, and my orthopod put me on disability. I ve had 15 plus knee surgeries after wreck. Two total knees, still non functioning. Pain and swelling persists. I was seeing a pain management dr. who left town, and I went to the primary dr. she had take over her practice about 8yrs. ago.

He has made multiple changes to his practice. Started out he wanted me to come in every month and get my scripts. After about 4 years. he came up with this idea, that he would have a new practice, and his patients that wanted to see him would pay $20 monthly if on Medicare, and $65 monthly if no insurance or commercial insurance. ON medicare, you would only owe your deductible, in addition to your monthly fee taken out of the bank account monthly. NO coinsurance would be owed or filed. The regular insurance would not be filed either, and office calls, etc would all just be part of the service. This was to do away with filing insurance.

However, he would file medicare and collect whatever they paid him. The patient just would not owe any additional amount to the $20 monthly. IF we wanted to continue to see him, we would join. I figured, it cost me $21.40 monthly for co insurance and I had to go in each month. This way I could just call and my scripts would be faxed. We were also to have 24 hr. daily access to him, by phone, and an apt within 24 hours if we needed one. From Jan 2016 when it started till 2017,no appts were ever necessary. I had one yearly exam in jan 2017, till he dissolved the practice with no notice in Aug 2017.

I never made any calls except my monthly 3 days before to fill my script. IN Aug, when I called for my meds I was told that practice no longer existed, and I would need to call back to his original clinic and get an appt. There I found out he had been bought out by a Hospital about 100 miles away. Upon arrival, I was given a letter stating I owed $196 from sometime in 2014 and 2015, and I MUST PAY IN FULL plus $200 deposit, before my next appt. I was also told that they had been turned to collections in Feb.2017, the day after they posted my medicare payment.

. YET< I have Never received any phone call message, voice mail or actual mail from the collection agency. There are 4 visits involved. 3 from 2015, evidently and my Jan 2017 visit. None of my pre collected payments showed on my acct. The payment would post as neg, be added back as positive, the neg again and then positive Therefore the starting amt owed as designated by medicare, after two already made payments made the ending balance the same as the beginning even though, I d paid $30 IN Jan 2017 I received notice from Medicare that I owed !01. deductible. THE DAY I GOT THE NOTICE< I took the payment in cash to the ofc manager at the pay as u go clinic and he told me that he did not take money to take it back to the original clinic. I went there and they had not posted the medicare payment and their payments "float " till Medicare pays , I have previously lost $50 and $70 that they never posted to my account.

So, I chose to wait and asked them to bill me when insurance paid. NO BILLS FOR OVER 2 YEars. This clinic is notorious for not filing for up to a bout 6 to 10 months after the fact of the appt. Back to letter. I looked at the first account listed, and it was for co insurance, I DID NOT OWE as I was part of the pay as you go clinic. SO, the ofc receptionist said that s right take it off. Down to $174 THe other 3 I may have owed $21 ON THE THREE, but they had been misfiled as rural clinic visits in 2015, and never billled to me. I actually had office visits monthly at that time. and not rural clinic visits. I saw him every month in the same exam room in the same building. So I take the letter, see the dr, WHO SAYS NOTHING, about this bill.

When I get home I look at the bill and find out about the rural clinic mis filings. and call Medicare, who tells me it will have to be refiled. SO I send a check and explanation of what I found (I Had previously been a credit manager for a clinic) and it is about $33 different to the office, as I have no address for the collection agency. I tell them to feel free to give it to the collection agency. WELL < I call for my next apt, as the DR is holding my scripts till I get an apt, and wont give me the apt until I pay the bill, I have been on these meds for 24 years. SO he sends back the check, and his receptionist tells me "DR. P is adamant that you pay the $200 deposit as the new hospital requires it."

I did not think due to their lack of billing and billing errors I should have to pay it. By this time, my meds are 10 days overdue, and I have so many personal things going on I decide to just pay it, ALTHOUGH HE SENT back my check. I d sent. so I call back the receptionist and he tells me "Dr said only way to not pay the $200 is to get a letter from the hospital."

I call the so mentioned hospital, and am told they did not partner with him, but the professional group had so she transfers me to that billing clerk Toni there who tells me That they had joined with the dr and this was the FIRST group of six that they "DID NOT DO THE BILLING OR INSURANCE and had Nothing to do with it. " IN addition, they had NO RULES REGARDING Payment in full or deposits of any amount before seeing the dr. Said she would talk to her manager and get back to me. WELL SHE CALLED BILLING AT MY DRS OFFICE and left a message.

Two days later I get a letter in the mail. that says. "DUE to our inability to resolve billing issues, I will no longer see u as a patient. Signs it and personally writes. Teresa, my feelings about our billings issues is overriding my feelings about your care, and you deserve better than that. " Signs it after telling me I am not to be seen by any dr there or at any of the 6 urgent cares in surrounding communities.

NOW< this is not about billing. This is about the fact that he lied to me and I found out because he lied to me. His receptionist told me to call and get a letter so I did. HE never spoke one word to me about the bill. and the errors are all the fault of his head clerk whom he hired off the street, who once told me that inpatients don't get billed.

They also kept billing me for outpt labs, till I took my medicare book in 4 years ago and showed them medicare paid 100% for outpt labs. This dr, like many others, just doesn't want to prescribe my pain meds. There are no other drs. in my town, closest is over 100 miles away. He also included a note that 30 days meds had been sent to my pharmacy. I went to get them 3 times before they were there a week later. This dr is aware I will find no dr in 30 days, where I live, esp around the holidays.

AFTER 8 years, he dug himself into a hole, by expanding too rapidly, forming multiple different practices and then needing to be bailed out. Then he directly lied saying the new provider required things they did not. Toni, even tried to get me to travel to their hospital about 120 miles away. In addition, I talked to multiple pts of his original practice, who also were to have been turned to the collection agency who never heard from it in the past year either.

This is a "man of faith" who repeatedly tells of the vision of his clinic, to care for the whole patient, their family , friends neighbors, and extended family. HAS IT POSTED ON HIS WAITING ROOM WALL. NOW money is all that counts. Although I am aware it will probably do no good, I m turning him in, to the new provider that bought him out, and the medical society. HE finds me so disposable, after I ve been the model patient for over 8years, doing everything he asked, never bothered him with phone calls, followed his protocol to a tee. EVEN when "Obamacare " as he calls it came into effect, and he told me that it required me ( who only had Medicare) to have monthly drug tests.

I called and asked Medicare and they said no I did not have to, but I never told him. After the first time and medicare did not pay, he never asked again. IN addition, the biggest reason I did not want to give me $200 is that his office has not even filed my Aug 2017 apt yet with medicare, and it would be over 2 years be fore I used it up. This has to stop. I ve been a legitimate, rule abiding, never called early never asked for more or early meds from him in 8 years. BUT what he doesn't like is being called on the ignorant billing system he has , knowing he is wrong. BUT directly lying to me was absolutly wrong. HE is now embarrassed that he has repeatedly lied and blamed it on the hospital taking over. Probably is collecting the money to get some back.

Drs, and employess have quit this office, due to paychecks being late, and one dr said costs way too high to him to work there at all. HE did not make any attempt to discuss this with me, and then said we had differences we could not resolve. Blaming me wont solve his problems. BUT has put me in a terrible place, with no way to get meds. This is how I m paid back for being as good of a patient as I could be. Professionally, I cooperated with everything he asked. He cant seem to find what makes him happy, and drags his practice from one type to another. I guess I wanted sympathy, I have no idea what to do, By the first I will have a week of meds left, and will not get a new patient appt then. Plus IN MO< u cannot depend on the weather. Feeling sorry for my self, but more angry that somebody else has that much control over my quality of life.

I made paragraphs to make your post easier to read.

Post Edited By Moderator (straydog) : 12/19/2017 4:38:36 PM (GMT-7)

Forum Moderator

Date Joined Feb 2003
Total Posts : 16302
   Posted 12/19/2017 6:03 PM (GMT -6)   
PR, wow, what an incredible story. I am sorry to read that are now without a dr & little pain medication. I honestly do not know what to think about this dr. I have to question his ethics & billing practices. In all of my years I have never heard of any dr practicing medicine as he did. Him selling his business, does this mean he is no longer in business? Was he an actual pain mgt dr or a PCP, I am a little confused.

He cannot dictate to you what drs you see now, unless he is part of a group. I know some drs will not see a patient of another drs, some little under the table agreement they make. I would make every effort to get him to agree to see you until you can get a new dr. It is his call to make.

I don't know, I would have been highly suspicious of this new clinic thing he proposed to his patients. Things just do not sound on the up & up. When you got your EOB's from Medicare did you ever look at them to see what he was billing Medicare for on each visit? Those old visits that were never filed, Medicare would have reduced the benefit for late filing.

Not sure why he told you Medicare wanted the UA's done. The CDC & DEA has those recommendations in the guidelines the dr go by when treating chronic pain patients. Some drs do them at random some every month.

You will need a referral to get in with a new PM dr & of course we all know that takes time. I just don't really know what to say because I have never heard of any dr working like this. I truly wish there was something I could say that would help you.

Take care.
Moderator in Chronic Pain & Psoriasis Forums

New Member

Date Joined Jun 2013
Total Posts : 19
   Posted 12/19/2017 9:14 PM (GMT -6)   
Wow! So sorry this happened to you. As if we pain patients don't have enough to worry about as it is.

I read and re-read your post and I really cannot figure out what this Doctor was trying to do. The following is what I found regarding Medicares rules on what a Doctor can charge.

"Participating providers agree to accept Medicare’s fee-schedule amount as payment-in-full for all Medicare covered services. When Medicare patients see participating physicians and practitioners, they are charged Medicare’s standard amounts and do not face higher out-of-pocket liability than the regular 20-percent coinsurance on most services. Participating providers may collect their applicable fees directly from Medicare. The vast majority (96%) of physicians and practitioners registered with Medicare are participating providers."

I know for a fact that Medicare has no rules on how often UA's are done. My Doctor does them quarterly. I cannot imagine that Medicare would want to pay for a UA on a monthly basis.

Used to be that I believed whatever a Doctor told me, but it seems you can't trust anyone anymore. If something sounds fishy, I assume that it is and would probably move on to someone else. Although in your case, you really didn't have any other choice and I get that.

Is it a possibility to talk to your family doctor (or a doctor of any kind that knows you well) and ask them to script your meds just til you can find an alternative? LIke another poster said, everyone knows it takes time to find a new PM, plus as far as you are going to have to travel to see one. Wow! It's just a suggestion but might be worth a try.

I would think that if you remind the doctor as to how many years you have been on these types of medications, he or she would realize that it might be dangerous for you to be without them and should be willing to help out on a short term basis.

So sorry this has happened to you! Please keep us up to date on how things are going for you.

Take care,

Post Edited (n2braves) : 12/19/2017 8:21:23 PM (GMT-7)

Veteran Member

Date Joined Jun 2013
Total Posts : 1716
   Posted 12/19/2017 11:12 PM (GMT -6)   
Obamacare has nothing to do with drug screens. I agree you should have been suspicious when he opened the new clinic.

Being a Christian does not mean the person can't run a business. Are you sure the note was your doctors handwriting? It it possible someone in the office wrote the note and pretended to be the doctor. Doctors can designate office staff to sign their name in some situations

If you have Original Medicare you do not have to have a referral.

If it sounds too good to be true. It usually is

Regular Member

Date Joined Nov 2010
Total Posts : 108
   Posted 1/5/2018 9:18 PM (GMT -6)   
The real reason he cancelled me is I used to be a credit manager for an osteopathic clinic of several drs. I know the rules of Medicare and what they pay. In the past, he tried to charge me a 20 percent co pay for out patient labs, and medicare pays 100% of what they approve for these and there is no copay. I hjad to take my book in to prove to him. At my next visit, he told me I "really pissed him off" HE fired me from the practice as he got the call from the new owner billing clerk that told me everything he said was the exact opposite of what was the truth. HE was pissed that I found out. I believe he is trying to collect $200 deposit for money to keep the clinic going. HE way over ex panded in the 8 years and doesn t file medicare claims for at least 5 months after the fact so has no money comeing in. I have written a letter citing the past 8 years and sent a copy to the quality assurance dept at the new owner of the clinic. I have already cited to him that he knows as well as I , that I will not be able tofind another provider in my town, let alone in 30 days I need at least 90 days worth of meds. AND he also knows what it will do to my body. Have not heard back. I also question he did not send the letter registered when he dismissed me from his practice.

Veteran Member

Date Joined Jun 2013
Total Posts : 1716
   Posted 1/13/2018 2:31 PM (GMT -6)   
It is never a good idea to make the doctor mad. Sometimes it is best to be quite. Hopefully he didn't write anything negative in your medical records that could affect another doctor prescribing you pain meds.

Veteran Member

Date Joined Dec 2012
Total Posts : 756
   Posted 1/13/2018 3:29 PM (GMT -6)   
How are you doing? This is a small forum. We genuinely care for each person who posts. Sometimes this forum is the only safe harbor for someone to express themselves and receive support and kindness.

I was a physical therapist and Healthcare consultant before ill-health found me. I thought I knew how to navigate the maze that is medical care. Nope. I have encountered more incompetent care than competent care.

Medicine is big business. Net profit reigns. Even as people suffer.

I hope you are doing as well as can be.
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Regular Member

Date Joined Nov 2010
Total Posts : 108
   Posted 2/24/2018 6:59 PM (GMT -6)   
UPDATE. To Dr. Firing me as patient

I have called every clinic in our town, and none are "prescribing pain pills". I have been in withdrawal, for two months now. I had saved back some meds, (prn) and have used them so sparingly I am in withdrawal about 5 days a week. I finally called a doctor about an hour away, and just stated I was looking for a new dr. ( turns out I worked with this dr in an er years ago). I also stated I wanted a doctor not associated with the hospital in our town. ( At least 85% refuse to use it). I did not mention my meds, and I was able to get an appt.

My saga with being dismissed for not wanting to pay$200, for nothing continues. I wrote to the new owner of the practice, as my dr still works there, just not for himself. Actually there are only2 doctors and NP that covers the urgent care part. The woman who responded to my letter OVER TWO MONTHS ago told me that three different people would be contacting me. NOT ONE HAS> I could not do anything about this dr, he just doesn t want to be questioned. HE wanted the $200 to get cash flow. I noticed that he had finally filed my aug.2017 apt, in Dec 2017, and that it is being filed by and address in Kansas City, I assume is a billing firm. BUT the co payments I had paid were actually applied this time. IN addition, a couple of weeks after that I got Medicare EOBS that he had filed a monthly chronic condition charge for $105 monthly. NOW REMEMBER HE WAS REFUSING TO SEE ME> the guidelines for this type filing say you have to be informed and give your written or verbal consent to be consider a chronic condition patient, that they also call and work with you all month, monitoring, that you have 2 o3 more conditions that will lead to death, etc. HOWEVER, NONE of this has been done. I did not get informed, did not give consent, and sure as heck don't have any chronic conditions leading to death, that I was ever told about. PLUS HE REFUSED TO GIVE ME AN APPOINTMENT DURING THESE MONTHS. In addition, I sent him a check, he returned. The $200 he cannot charge as he accepts Medicare assignment, and he cannot bill for future services, only those u receive. HE has broken so many Medicare rules, yet Medicare really does not care. I can file a complaint, but nobody will do anything. I am sending a second letter to the hospital prof group that own him and to several other places. citing his care. After being on meds, fentanyl patch for over 20 years, discontinuing me the way he did could result in my death. I technically need at least a year to detox. HE KNEW THAT, it was just his way of getting back at me for actually questioning his billing practice. THE MAN never spoke ONE word to me, HE had his receptionist call me and he sent a letter, not certified. THIS is complete disregard for my health. HE was completely aware of my conditions. HE knows my walking and activity will be limited, esp with NO meds. HE just does not give a darn, and this type person should not be a doctor. HE does not want to give out narcotics, and should just refuse those patients in the first place. The funnything is he told me one day that he takes a med that he needs 3 times a day but insurance will only pay 2 times a day, so he buys it outright for the third. HE deserves meds no matter what, but I am disposable. THIS has really made me angry. I am going to report this behavior to as many place s as I can. I sent him a letter stating that he had been unfair in his treatment of me. That I only did what his receptionist told me he said I had to do. I followed his instructions, and then he punished me by taking away my meds. I also told him he was well aware, that I would not find anybody to take on those meds in 30 days, esp without a referral. By the way, the chronic care he was charging for me REQUIRES patient referral. HE GAVE ME NOT ONE NAME, as there are none. THIS IS WRONG on so many levels.

I ve been reading about the (for lack of a better term) physician made addicts that are being hung out to dry. An ortho dr. had her pain dr. of 30 years plus quit prescribing her methadone, She , of course, was able to find another dr. She had practiced on methadone all these years. Two others were told by their drs. this is our last month, cannot give u any names for referral, here is 30 days worth of meds, I am so sorry. but the clinic is closing and going to an addiction center. THESE two committed suicide, one because he could not face it after 20 years of pain control, and the other within 2 weeks of running out of meds, and not finding a dr.

We all know going to the ER is not an answer, you are just a pain pill seeker. I cooperated and did everything asked, for over 20 years and am being treated like this. IN the throes of withdrawal, YOU really don't care if you live or die. IT IS HELL. I read where now Medicare has recommended no more than 90mg MS equivalent a day, when I thought last year it was 240 mg. I also read that cancer pain will soon be the only pain they are willing to treat. So many drs did not bother to read that this was for new pain med users. not the chronic compliable patients of many years. Also that ortho drs are not giving 7 days or 20 pills post op knee replacement with no refills. THAT will be hell also.

I m hoping this dr will continue my meds or at least start me as detoxing over a year, so if I can't walk at least the withdrawal will not kill me. I do not understand the purpose of becoming a dr if you are not willing to treat pain. After recommending pain level be the 5 th vital sign, they are taking that off too.

I fell down a flight of stairs, and that on top of what I m going through has aged me at least 15 years in the past 3 months. I know I did not get good care, but somebody wo cares so little for his patients should not be allowed to continue to practice medicine. Worse thing is this drs daughter is the best friend of my granddaughter. so I have to be very careful when I talk. I will continue to try to getcare. BUT have serious doubts. I do not think I can live thru withdrawal with no help. I make it 3 days, and break down, each time. This was done to me, not by me, and I truly resent how it has been handled. The dr did not bother to respond to my letter. I did notice he has had new complaints about his practice recently.

This happened basically, because this man decided he could build a new clinic 1 year out of residency, (a three story building with 144 employees plus . HE had only 2 drs and 144 employees, THIS IS ONE OF HIS biggest problems. HE had a billing system, that accumulated at least 6 months of interest, before insurance payment was processed, and then you had to ask to have the interest credited, and the copays you had to make before seeing him, never posted. They did not send out statements for over a year at a time. They hired billing clerks off the street, with no experience,. After the office was uilt, he started an urgent care clinic. then expanded to 6 more in towns within 50 miles of KV in the next 3 years, then started the monthly pay but not see him clinic for a year. ( I also found out he founded that clinic in Jan 2016, and by April 2016 had already started negoitations with the hospital to take over all his practices, then dissolved the clinic in Aug 2017 with no warning to any of the patients. HE has no money because he over expanded and has too many employees. As a monthly patient, I rarely saw the same nurse twice.

BUT none of this had anything to do with me, other than I did not think I should pay what I did not owe I know he would not. THIS IS SO UNFAIR, and yet we all know he holds the cards, and I cant do anything about his treatment of me, except to report it. THEN it is up to the powers that be. Medicare is constantly asking for reports of abuse, but I bet they do nothing about getting back the money they paid him for those chronic care payments, that I knew nothing about.

I appreciate the concern. I m just telling you , we all have to play the game, and I did for over 20 years and still this happened to me. I don't care if he is more angry now, I M ANGRY TOO That he would treat another human being like he has me, or that he would take advantage of elderly patients, and make them pay him$200 upfront, to keep his office going.

Forum Moderator

Date Joined Feb 2003
Total Posts : 16302
   Posted 2/25/2018 9:15 AM (GMT -6)   
The prescribing guidelines Medicare is using was put into effect by the CDC & FDA. These guidelines have been in effect for quite some time, they are not new. PM drs also started going by these prescribing guidelines to keep from being flagged. Several years ago many patients suddenly found their dosages vastly reduced or cut off completely with no options except to try to find another dr. When these patients were released by the drs they were not given medication until they found another dr. Some states has adopted stricter prescribing practices. Pain mgt is so restrictive & getting worse.

I highly suggest that you lay off trying to expose this dr.. You are making a paper trail that will follow you around. This new dr in all probability will have you sign a release to obtain your records from the previous dr & you have no idea what has been put in your records. I would tread very lightly. As angry as you are it is not helping you at all. If there are negatives things written in your chart the new dr may decide he does not want you as his patient & it is his right to make that decision. This may all work against you in getting future care. Being a nurse you are very much aware of how drs have a certain kinship even if they disagree with what another dr has done with a patient.

I have been on Medicare for years & have never had to sign anything for a chronic condition charge. I have regular Medicare & a supplemental policy. On my EOB's from Medicare it asks if charges are Medicare approved. I have never been checked on several times a month by someone either. Not sure what you are talking about. I am under the care of a few specialists & treating me can be sketchy at times. I am guessing you have a Medicare HMO or advantage plan since you have co-pays.

I always look at every EOB from insurance & Medicare. If I had a question on something not being paid I would call insurance before calling the drs billing office. More often than not it was a CPT code entered incorrectly & it would be rebilled & paid. A little over 4 years ago my PM dr retired & referred me to a new dr. He was filling my pain pump & his billing office had my insurance messed up. They were billing the secondary first & of course no payments were made. In the computer at the drs office they had my insurance correct & they made numerous calls to billing. After about 8 months of this mess, I had an appt with my dr & I told him what the billing office was doing. I explained his office was not at fault & were getting no where with the billing office. First off, he was surprised that I had even bothered to look at my EOB's & I told him, I look at every one that I get plus I can go online & check things out. He said not many people do this & I appreciate you bringing it to my attention. I told him that I did not think I was a patient that fell through the cracks with that office & there was no telling how many others he had not been paid on. He had no idea there was a problem with his billing office. He ended up firing that billing office & I have never had another problem. Point is, drs rarely get involved with billing, they have a staff that does all of the coding for billing & then the billing office takes it from there. What your prior dr was doing I have no idea.

Some drs will not prescribe meds on the first visit so do not be surprised if this happens. Often we see the dr require a UA & then the patient goes back in 2 weeks & he makes the decision on meds.

Take care.
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