Pre-Authorizations cause Chronic Pain too
Hello, how you be?
I’m obviously biased and opinionated. I’d have to check, but I’m confident I’ve never pretended otherwise. Like most, I have opinions that are based on my knowledge, life experiences, interactions with humans, and the tv (I listen well when the tv speaks). Since I’m almost never satisfied or content with my abilities, I do believe I have an open mind and am willing to adjust as needed. To put it another way, I’m always willing to steal knowledge from you and then claim it as mine so I can work smarter, not harder. But I guess that says more about who I am as a person rather than the point I’m trying to make. That point is: are pre-authorizations (some say prior authorizations) just plain stupid and potentially hazardous to a patient’s health at this point?
To answer one of your questions, no this is not some random hostility towards a rather common and routine practice in our healthcare system. As most chronic patients can attest too, we need a pre-authorization for everything from a Band-Aid to a heart transplant it seems. Pre-authorization is designed to be a cost control process for medical necessary procedures or medications. In theory, and preached by health insurance companies of all stripes, it also forces doctors to justify and defend their medical opinions which does add a layer of protection for us patients. However, as I found out yet again while trying to pick up my Nucynta prescription at the Fred Meyer’s, in practice all it does is force me to go through withdrawals while my doctor fills out yet another report stating that the med (Nucynta which I have been on for 10 plus years now) works while Blue Cross takes up to 5 days to read and agree with his assessment.
To backtrack for a second so we are all the same page, Nucynta is an opioid analgesic for which I take to help with my pain mainly related to the rheumatoid arthritis. It is also commonly prescribed for diabetic peripheral neuropathy pain. I take the extended-release version twice a day and have had a great deal of success while on it. For me, it helps reduce and often eliminates the pain from a rheumatoid arthritis-based flare. Like I said earlier, I have been on this medication for 10 years now. Now is probably a great time to mention that I do not care what your opinion of opioids is, for me they are a medication to help control the pain from multiple health conditions that are causing me chronic pain.
When I was first prescribed Nucynta, I was covered by Blue Cross as a state employee. Since I am currently unemployed, I’m still with Blue Cross but I had to purchase my current health insurance off their website. As is common procedure, I went through a pre-authorization process when I was first prescribed this medication. Despite assurances from Blue Cross when I first purchased my current plan that my pre-authorization would transfer to my new plan, it did not which meant I had to go through it again. Many of you might be thinking “so what”, it’s not like the pre-authorization process is that complicated or time consuming. On a high level or policy perspective, this might be true, but on a patient or human level, it put my health and quality of life at risk.
Much like many other types of medicines, stopping Nucynta “cold turkey” style is not recommended by the drug manufacturer, my pain management doctor, the nurses at my pain management clinic, or common sense. By forcing me to stop “cold turkey” style and go through a new pre-authorization process (mind you they paid for my Nucynta the previous month without so much as a blinked eye since I was still on the state’s plan), Blue Cross caused me to experience a significant increase in pain, restlessness, insomnia, increased stress on my heart, and a loss of appetite. In this case, I had to go through all that simply because someone at Blue Cross decided at the last second that I do indeed need a new pre-authorization for my medication. My health was put into jeopardy because someone at Blue Cross deemed a piece of paper with a report from my pain management doctor invalid and wanted a new piece of paper with a report stating the exact same thing.
Despite Blue Cross putting their paperwork need over my health, I survived and was able to regain control of my pain once I was back on the Nucynta.
Fast forward 11 months to April of this year. Thanks to the nonsense and scare tactics used to create current opioid policy, my doctor can’t prescribe any refills for my Nucynta. As a quick reminder, I take this med regularly and on a long-term basis because there is no cure for rheumatoid arthritis, only management. This means I must schedule an appointment every month before I can get a refill, a gross use of resources since some of the appointments last less than a couple of minutes if I’m “stable”. Anyways, I was approved for another month and the prescription was sent to Fred Meyer which I’m contractually obligated to use regardless of reason just to let you all know. My appointment was early on a Friday.
Like a good, engaged patient, I was logging into Fred Meyer’s website to get updates throughout the day. As of 2pm that Friday, everything was proceeding as normal so I went to the gym thinking I could get in a workout in (movement is medicine) then swing by the pharmacy at around 5pm to pick up my Nucynta and dinner. A “kill 2 birds with 1 stone” strategy in the life of a chronic pain patient like me. However, while in the middle of my workout, I get an automated notification from Fred stating my Nucynta can’t be filled at this time but no reason as to the why was included. Concerning or alarming, not sure what word works best. Hoping and assuming it is probably a supply issue for which I can’t do much about, so I finish my workout and head to Fred’s.
Guess what, chicken butt. I miss teaching little kids because they have the best jokes.
Seriously, guess what, the delay wasn’t related to a supply issue. Blue Cross wanted another pre-authorization. For those of you that are details people, you have probably already figured out that since its around 5pm on a Friday I’m not going to be able to contact my doctor until the following Monday. Also, as most of you know, I’m considered a highly engaged, active patient advocate who would have asked my pain management clinic to send in a new pre-authorization the previous month if I would have been told by Blue Cross that I needed another one. This time I did call Blue Cross to ask, “what the living hell is going on?” for which I received a bunch of words from Blue Cross that had no real meaning whatsoever. Long story short, I was going to have to go through withdrawal symptoms once again due to Blue Cross’s apparent fetish with paperwork from a fax machine (remember, I opened this post stating that yes, I’m indeed biased and opinionated).
This is a FYI for fellow chronic pain patients, especially new ones. Blue Cross tried to convince me that my doctor could mark RUSH on my pre-authorization request. Much to no one’s surprise, this was utter bull. RUSH is only for patients that need their medication now or they will die shortly after now.
Fast forward to earlier this week. Since I had another radio frequency ablation on my neck about 6 weeks ago, my monthly doctor appointment routine got thrown off. Thanks to some side effects from that procedure (I’m still living with those side effects), I went in early to get looked at. I thought the doctor was going to call in my Nucynta prescription, so I didn’t have to come back the following week for it, I guess I was wrong, or he forgot because Fred Meyer had no idea what I was talking about. Due to the confusion, I was already several days into withdrawals because of the mix up when I stopped by my doctor’s office to get it fixed. You dabble in the chronic life long enough; you are bond to have a mix up or two along the way.
This was Wednesday when I stopped by the office. Since Fred’s can be slow, I took the long way there after receiving confirmation from the front desk that the doctor had called in my prescription. To both keep a long story short and my blood pressure under control, the pharmacist at Fred Meyer told me they couldn’t fill my prescription because Blue Cross needed another yet pre-authorization. Shocked? I was more angry than shocked but there was some shock involved.
Maybe it was arrogance, maybe it was a strong desire to ruin some Blue Cross employee’s day, but I decided to call my health insurance company from the parking lot of the pharmacy to verify that they indeed needed another pre-authorization. Sure enough, the condescending customer service person I spoke to verified that pre-authorizations where only good for 6 months now. She proceeded to blame me for not reading that in my previous pre-authorization approval letter that was never sent to me and blamed my doctor for not knowing this. In addition, she suggested I set a reminder in my IPhone’s calendar a hand full of times in a span of 2 minutes and probably would have said it more but stopped when I asked her to “assume that I was indeed smarter than a 2nd grader.” To her credit, she did find a way to suggest I set a reminder in my phone while apologizing and promising that her intention was not to insult me.
Word of advice if you ever choose to employ a similar game plan, don’t say a word after your insurance company customer service person offers a fake apology, they are not trained for this silence which makes them uncomfortable. It’s kind of funny when you are going through withdrawals because of paperwork that says the same exact thing every time. I know, this was immature and unproductive of me, but I don’t care since the beast won again.
Why write this post? Was it just to show off my obnoxious skill set?
There are two reasons I’m sharing this story...
First, patients that choose to utilize opioids should know that the current system is set up to both monitor our every move and to push them to the brink of failure. It is designed to put patients in danger because of a paperwork fetish which can then be used against us as evidence of our “addiction”. That simple, common mistakes due to the fact no system can ever be perfect, will cause us to go into withdrawals but it’s not our fault.
I’m confident that even if Blue Cross buts a negative remark into my file, that won’t prevent my pre-authorization from being approved. I might be known as a difficult patient according to Blue Cross’s database, but I’m ok with that. In the end, even though my health insurance premium is less than budget dust to them, I’m still a paying customer which gives me a tiny bit of leverage. Yes, I might get a warning or slap on a wrist, but chances are I won’t receive a punishment of any real consequence at this point this time. I don’t recommend pushing your luck and doing something like a did on multiple occasions…even if it is deserved or justified.
Second, people are neither good nor bad in my experience, they are just people. Human caused problems are caused by the conflict that arises when our better angels try to party with our political beliefs. When both drink a beer together, we can get cures for cystic fibrosis or even cancer. However, when one wants to drink water while the other is looking for a vodka tonic, we get trouble. In this case, we get opioid policy prescriptions that are not conducive to the chronic pain, or any type of pain for that matter, experience. To put it another way, my quality of life suffers so others can fill comfortable with their vodka tonics.
We take great pride when our better angels and political beliefs design a new policy. Our political leaders celebrate it, academic types study and publish evidence in support, and healthcare spends millions and millions celebrating when these worlds innovate together. However, not to be a Debbie downer, but this does not mean patient centered care has been achieved. Patient centered care is when I get to be selfish and pursue a higher quality of life despite my illnesses and conditions. It’s me skiing a powder run even with my neck issues. It’s me not going through withdrawals because someone needs a new report with the only change being the date at the top.
In a matter of hours now, we are going through one of the most contested, and nasty elections in our country’s history. We have one candidate who would look at my story and either blame me or give Blue Cross the benefit of the doubt simply because they are a corporation. They would argue that my story proves why we need to deregulate the health insurance industry even more. As a long-term chronic patient with degrees in political science and accounting, I can prove deregulation is nothing more than allowing Blue Cross (or venture capital types) to make more money off me and other patients. It has very little to do with my quality of life.
The other candidate, Harris/Walz. They have shown they understand that the ACA (Obama care) is not perfect, but it has made healthcare better than it was. Ask any chronic patient about the nightmare and suffering caused by not covering pre-existing conditions. Ask any parent whose kid was diagnosed with cancer only to have their health insurance drop them because their kid couldn’t contribute financially to the company’s bottom line. Harris/Walz understand that if I’m experiencing withdrawals due to a paperwork fetish, that is a symptom of a larger problem and not just the cost of doing business as a health insurance company.
Healthcare is not going to be fixed or changed based on an ideology. It most definitely isn’t going to get better appointing a dude who thinks driving down the interstate with a shark’s body attached to the roof is a smart idea (do some research on RFK Jr if you don’t know what I’m talking about). "We need leaders who understand the difference between popular policy and patient-centered care. We need leaders who are sympathetic toward my plight as a chronic patient rather than looking for reasons to deregulate. We need leaders who encourage innovation but understand people still need to come first. I can accept that it was probably my turn to have a prescription called in late due to a misunderstanding, what I can’t accept is a system that proclaims to understand rheumatoid arthritis and the pain it causes but will go out its way to prevent me from getting the medication that has helped me the most to enjoy a higher quality of life.
