Our doctors have been sent letters by the insurance companies demanding prior authorization for narcotics and that the doctors document that patients show improvement to continue to receive their medications. I think we need a new case, as in the Jimmo Settlement, or legislation, to include medication as treatment that cannot be denied.
We who are in chronic pain and will not improve but need services to prevent deterioration should be aware of the Jimmo v Sebelius case which decided in our favor. The official government Jimmo case website: /www.cms.gov/Center/Special-Topic/Jimmo-Center.html
There is a clarification page from the government also: /www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf
I'm a Post-Polio Syndrome (PPS) patient, and I will not improve. I will continue to deteriorate. (Many other conditions, including broken neck and other injuries with permanent sequelae.) On my last visit to my pain doctor of ten years I was required for the first time to have a urine test. Yes, I know most others have that all the time, and I don't object. Is this going to be every visit now? What does "recent" test mean?
The main concern is the government and insurance companies are trying to get us off our pain meds, and we don't have a case, like Jimmo, to protect us from unreasonable discontinuation. While I agree with monitoring and control, denial because we do not improve is unconscionable.
Gave your post a title.
Post Edited By Moderator (straydog) : 7/5/2018 10:25:04 AM (GMT-6)