Email steve@steveariens.com 502-938-2414
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This disabled female pt reached out to me about a week ago and her doc had just abruptly cut her oral opioids she had been taking for ~ 10yr from 90 MME/day to 30 MME/day and put a Buprenorphine patch on her the next day. This is just starting to evolve but I am going to leave this post at the top of the first page an update as things happen – STAY TUNE
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Twofer most commonly refers to a coupon, ticket, or deal that allows you to purchase two items (especially event tickets) for the price of one. The term comes from “two for (the price of one).”
While this is the primary and most widely recognized meaning, “twofer” can also be used more broadly to describe:
Any situation, offer, or arrangement where a single action yields two benefits or returns—essentially, “killing two birds with one stone.”
I started this blog back in 2012 because I have always preferred to remain on the outskirts of the community—ready to assist any patient, advocate, or individual in need when I can.
Over the years, I have noticed some recurring infighting among advocates. Sometimes, it seems like people are jockeying for visibility or for more time in the spotlight. I never really understood this, so one day, I expressed my confusion to Barb. Her simple explanation:
“You’ll never understand it because you were never a female in junior high or senior high school.”
Another area of concern in the nonprofit sector is the question of how donations are raised and used. Sometimes, people suspect that insiders are benefiting more than the cause itself. The specific term for this, when someone inside a nonprofit uses an undue amount of funds for personal benefit instead of furthering the organization’s mission, is “private inurement.” This occurs when insiders—such as a board member, officer, or founder—receive disproportionate benefits from the organization’s resources or assets.
I’ve created this page because there appear to be many individuals claiming to be pain advocates, but some (in my opinion) seem more focused on raising money and collecting donations rather than taking real action. I do not need the money, and I will never directly ask the pain community to support me financially. If my help, education, or motivation has made a difference for you and you would like to make a donation, I’ve listed five charities that Barb and I personally support below. There is no expectation or set amount—only consider donating if you feel moved to do so and can comfortably afford it. If you’re having trouble making ends meet, I urge you not to donate funds needed for your own bills.
My philosophy is simple: If I can help a chronic pain patient, and they, in turn, can make a donation to a national nonprofit that helps another family—that’s a “twofer.” Everyone wins.
https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues
https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects
https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital , three other major hospitals are within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTER for 100 miles and part of a medical university and helps provide housing for families with kids in the hospital
https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families
https://www.woundedwarriorproject.org/ their list of services is quite extensive and here is a hyperlink of what they do https://www.woundedwarriorproject.org/programs
https://www.4apdf.org/ American Pain and Disability Foundation The American Pain & Disability Foundation is dedicated to helping individuals with chronic pain conditions. Our mission is to enhance the quality of life for patients and provide essential support services, and education for better pain management. At the time of this post Bob Sheerin is President and focuses on trying to get pain medications for kids
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can you compare the similarities and differences between the way that the DOJ/DEA extract money from businesses selling a legal product and the stories that I have heard about bullies or mafia would use threats to extract money out of the owners of store front businesses in order to keep their stores from being damaged?
The methods used by the DOJ/DEA to extract money from businesses through asset forfeiture and the tactics employed by mafia groups for extortion share core mechanisms of coercion and financial extraction but differ fundamentally in legality, oversight, and objectives. Below is a structured comparison:
Financial Coercion:
Both involve taking money or property from businesses under duress. The DEA uses civil asset forfeiture to seize cash or assets suspected of links to drug crimes without requiring a criminal conviction. Similarly, mafia groups demand “protection” payments from businesses under threats of violence or property damage.dea+4
Lack of Proportional Proof:
DEA administrative forfeiture allows seizures based on probable cause alone, often without formal charges or judicial review. Mafia extortion relies solely on intimidation, with no legal burden of proof.ij+3
Systemic Impact:
Both create climates of fear: Businesses face financial harm regardless of guilt (DEA) or compliance (mafia). For example, DEA seized $3.2 billion administratively since 2007, while Sicilian businesses paid thousands monthly to avoid mafia retaliation.good+3
| Aspect | DOJ/DEA Forfeiture | Mafia Extortion |
|---|---|---|
| Legality | State-sanctioned under laws like CAFRA; considered a law enforcement tooldea+1. | Criminal activity; violates laws against racketeering, bribery, and violencebusiness-law-review.law.miami+2. |
| Methods | Legal processes (e.g., notices, claims, court filings); owners can contest seizuresdea+1. | Illegal intimidation: threats, bombings, murders, and forced “insurance” paymentsbusiness-law-review.law.miami+2. |
| Oversight | Limited judicial review in administrative forfeiture; constitutional due process appliesdea+1. | No oversight; victims rely on police protection, often ineffectivegood+1. |
| Purpose | Aims to disrupt criminal enterprises (e.g., drug trafficking)dea. | Expands criminal control; profits fund illicit operations (e.g., drugs, money laundering)business-law-review.law.miami+1. |
| Target Scope | Focuses on assets tied to suspected crimes, even if business is legaldea+1. | Targets any vulnerable business, regardless of legality (e.g., shops, construction)good+1. |
Accountability: DEA seizures can be challenged in court, but 81% of cash seizures occur administratively without judicial scrutiny. Mafia victims have no legal recourse; non-compliance risks violence.anthropologyreview+3
Scale of Control: Mafias infiltrate entire sectors (e.g., Foggia, Italy, where businesses paid mandatory “premiums”), while DEA actions are geographically and jurisdictionally bounded.antimoneylaunderinglaw+2
Incentives: DEA forfeiture revenue funds law enforcement, whereas mafia profits fuel further crime.business-law-review.law.miami+2
In essence, both systems extract wealth through pressure, but the DEA operates within a legal framework—however flawed—while mafia tactics are purely criminal enterprises built on fear.
Recently DOJ/DEA “extracted” millions or billions from CVS & Walgreens with only allegation that they filled MILLIONS of illegal prescriptions. There was apparently no real probable cause. In reality, CVS & Walgreens do not technically fill controlled medication Rxs, it is the pharmacists that work for these companies that determine if a Rx is valid, medically necessary. Those two chain pharmacies only have a license to operate Rx depts and must have a pharmacist on staff and at least one pharmacist who is considered “Pharmacist in Charge” and legally responsible to the state board of Pharmacy to make sure that the pharmacy follows the rules. Any idea why the DOJ/DEA goes after the pharmacy corp, other than a “money grab”
The DOJ and DEA’s pursuit of pharmacy corporations like CVS and Walgreens—rather than just individual pharmacists—has legal, regulatory, and practical foundations, and is not solely about extracting money, though the scale of settlements is certainly significant.
Legal and Regulatory Framework
Corporate Responsibility: Federal law, particularly the Controlled Substances Act (CSA), places responsibility on both pharmacists and the pharmacy entities themselves to ensure that prescriptions are valid and filled for a legitimate medical purpose. Pharmacists are considered the “last line of defense” against improper dispensing, but the law also holds the pharmacy business accountable for establishing and maintaining systems to prevent violations.pslhub+4
False Claims Act (FCA) Liability: When pharmacies seek reimbursement from federal healthcare programs for prescriptions that are not valid, they can be held liable under the FCA. This is a civil, not just criminal, liability and can apply to the corporation as a whole.bassberry+2
State and Federal Oversight: While state boards of pharmacy regulate individual pharmacists and require a Pharmacist-in-Charge (PIC) for each pharmacy, federal agencies like the DEA oversee the broader compliance of pharmacy businesses with federal controlled substance laws. The DEA can revoke a pharmacy’s registration if it finds systemic noncompliance.justice+2
Why Target the Corporation?
Systemic Issues and Culture: DOJ and DEA lawsuits allege that pharmacy chains fostered corporate cultures or policies that pressured pharmacists to fill prescriptions quickly, ignored red flags, or failed to provide pharmacists with necessary information to make informed decisions. For example, Walgreens has been accused of systematically pressuring pharmacists to fill prescriptions and preventing them from sharing information about known bad prescribers.medpagetoday+1
Scale of Violations: When millions of prescriptions are alleged to be filled improperly across thousands of locations, the government contends that the problem is not isolated to a few “bad apples” but is a systemic failure requiring corporate accountability.fiercehealthcare+2
Precedent and Deterrence: Targeting large corporations is seen as a way to send a message to the industry and deter similar behavior. The “corporate social responsibility” theory of liability is increasingly used to ensure that companies implement robust compliance programs.uspharmacist
Resource Allocation: It is more efficient for federal agencies to negotiate large settlements with corporations than to pursue thousands of individual pharmacists, especially when the alleged misconduct is widespread and involves corporate policies or practices.medpagetoday+1
Pharmacist vs. Corporate Responsibility
Pharmacist-in-Charge (PIC): While the PIC is legally responsible for the pharmacy’s compliance with state and federal laws, in large chains, many decisions are made at the corporate level, and the PIC may have limited authority over policies and staffing.pmc.ncbi.nlm.nih
Corporate Policies: The government alleges that corporate policies—such as performance metrics, staffing levels, and information-sharing practices—can create environments where pharmacists are discouraged from exercising their professional judgment.fiercehealthcare+1
Summary Table
| Factor | Pharmacist Responsibility | Corporate Responsibility |
|---|---|---|
| Legal Basis | State pharmacy law, CSA | CSA, FCA, corporate liability |
| Enforcement Target | Individual licensure, discipline | Civil/criminal penalties, fines |
| Alleged Misconduct | Filling invalid prescriptions | Systemic policies, culture |
| Scale | Individual or local | National, thousands of locations |
| Purpose | Professional accountability | Industry deterrence, compliance |
Conclusion
The DOJ and DEA go after pharmacy corporations because federal law holds them responsible for systemic compliance failures, and because large-scale violations are often rooted in corporate policies or culture, not just individual actions. While the financial settlements are substantial, the government’s stated goal is to protect public health and ensure compliance with laws designed to prevent opioid abuse and diversion. However, critics argue that the lack of clear regulatory guidance and the broad discretion given to prosecutors can make these actions feel punitive or arbitrary to some in the industry.corporate.walmart+4
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This simple math would strongly suggest that the war on drugs has not basis in MATH. It is pretty common knowledge that addiction – regardless of what a person is demonstrating addictive behavior about – There is typically stated that addiction has a substantially underlying mental health issues. The Graph below that there is abt 4.8 million people =>12 y/o are dealing with OUD. It is routinely stated that there is some 100 million people dealing with chronic pain and others claim that certain opioids are EXTREMELY ADDICTING.
The number of prescription opioid doses dispensed in the United States each year has varied but has been estimated to be in the tens of billions of dosage units annually. The DEA reported figures ranging from 12 to 17 billion dosage units dispensed at the retail level in recent years.
over 120 million opioid prescriptions dispensed annually
SO, if – as some claim – that many/all opioids are EXTREMELY ADDICTING, why is there only 4.8 million people dealing with OUD?
The question has to be asked? Why are we refusing to treat chronic pain pts, if the numbers would suggests that we are denying the majority of chronic pain pts from having their chronic medical issues properly treated, just like we treat all other people with chronic medical issues. Since most of the chronic pain pts are DISABLED, why is our system discriminating on this category of disabled people?
Could it be that our DOJ/DEA has had an agenda since 1970 and it is unthinkable for bureaucrats to admit they have been wrong? When is the last time anyone has heard a bureaucrat admit they were wrong?
In 2024, 4.8M people (12 or older) had a past year opioid use disorder. Of those, 17% (818,000 people) received medications for opioid use disorder (MOUD) in the past year. More data in the 2024 hashtagNSDUH: samhsa.gov/data/nsduh
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Notice in the DEA notice I pulled off the web. Notice that they LABELED the CASH as ILLICIT but all the items that are identified as “NARCOTICS”. I am not sure what is lying on the table but all narcotics are a controlled substances, but not all controlled substances are narcotics. Notice those bags of some “blue tablets”. Most likely, they are tablets made by the Mex cartels of an illegal Fentanyl analog – one of the 100-200 known fentanyl analogs that is not the same Fentanyl that is used in what the FDA has approved for being safe to be used in humans. There is no commercially made Fentanyl tablets, so all those tablets are ILLEGAL/ILLICIT Fentanyl analog – what I have read the Mex cartels are producing – from precursors from mostly China – Fentanyl acetate, not the Fentanyl citrate that is FDA approved and what is used in the USA for pain management and surgeries.
IMO, so the DOJ/DEA & our media is misleading John Q. Public about what all these 100,000+/- people who are ODing & being poisoned by these illegal Fentanyl tablets and other illegal drugs. Thinking that they are dying from using/abusing the legal Fentanyl citrate.
There was a infamous man in central Europe in the early 20th century that had a phrase that he lived by and mislead the people in the country that he was actually a Dictator over. His saying was: “MAKE THE LIE BIG, MAKE IT SIMPLE, KEEPING SAYING IT, AND EVENTUALLY THEY WILL BELIEVE IT” Does this sound like what the DOJ/DEA/MEDIA is doing?
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There is a good video on the hyperlink below. The questions has to be asked, if ~40 states can make Marijuana legal – when it is illegal at the federal level designated as a Category C-1 and the DOJ/DEA have pretty much left those states alone.
First state to legalize medical marijuana: California, 1996
First states to legalize recreational marijuana: Colorado and Washington, 2012
Sec Kennedy’s agenda is MAHA ( Make America Health Again) how can 20% to 30% of our society is dealing with chronic pain have a DOH/DEA from interfering with the practice of medicine and the adequate treatment of pain.
As of August 2025, seven states have made kratom illegal. These states are:
Alabama
Arkansas
Rhode Island
Vermont
Wisconsin
The Indiana Board of Pharmacy has a total of eight. These members are appointed by the Governor and serve four-year terms. The composition is as follows:
Six licensed pharmacists (from a variety of pharmacy practice settings, with at least one working as a hospital pharmacist)
One member representing the general public, who has never been associated with pharmacy except as a consumer
Additionally, recent statutes clarify that one board member is a pharmacy technician in good standing, actively practicing and certified in Indiana
This structure ensures diverse representation from across the pharmacy profession and includes the public’s perspective on pharmacy regulation.
Indiana was the last the last state to mandate generic substitution and some suspect that a large building in down town Indianapolis – with the LILLY name on top of it that can be seen from the Indiana state capital had some influence in mandatory generic substitution being stalled until they were the last standout and the legislature had little justification to not enact mandatory generic substitution.
Seven years after the Centers for Disease Control and Prevention released guidelines aimed at stopping the over-prescription of opioid painkillers, patients who need those medications to ease chronic pain have been left suffering, some to the point of suicide.
Now, state Sen. Joanne Ginal is stepping in with a bill to help.
“We’ve done a great job at reducing opioid addiction but we need to pay attention to those people who need opioids in order to just live a normal life,” she said.
According to the CDC, chronic pain impacts 20% to 30% of the population and 60% to 70% of people over age 65.
The new guidelines were catastrophic for many of them as some insurers denied reimbursement, pharmacies set strict limits on prescriptions, and many doctors began turning those with chronic pain away or rapidly tapering them off the only drug that gave them relief.
Christina Johnson with the Colorado Center for Aging is among those who were impacted.
“Responsible use allows me to continue to be here and participate in life,” she said.
Diagnosed with degenerative disc disease, osteoarthritis, and scoliosis, she has lived with chronic pain for nearly 50 years.
“It feels as if somebody puts a knife into my lower back,” she said.
Morphine, she says, is the only drug that eased the unrelenting pain, but when the new CDC guidelines came out, her doctor abruptly tapered her medication.
“I was much more functional than I can do right now,” she said.
Julie Reiskin, with the Colorado Cross Disability Coalition, says many doctors are refusing to treat patients on opioids altogether leading some to turn to the black market.
“We’ve seen a lot of our members who were stable, who were working, who were contributing, who were part of society — they’re now lying in bed. We’ve lost people to suicide because they couldn’t get their pain treated, including a 17-year-old volunteer with us,” Reiskin said.
For more than a year, Ginal has worked with doctors, pharmacists, and patient advocates to draft a bill that protects providers who prescribe high-dose opioids from disciplinary action, prevents them from denying treatment based on a prescription, and prohibits them from forcibly tapering a prescription.
But it does not mandate providers prescribe high-dose opioids. Reiskin says it will be life-saving.
“We have people that have been at home for years and years on end because they can’t get treated and it just has to stop,” Reiskin said.
The CDC recently issued new guidelines that still recommend non-opioid pain management when possible, but also acknowledge that physicians should decide what’s best for their patients.
Ginal’s bill passed the Health and Human Services Committee unanimously.
Senator Joann Ginal’s bill in question is Colorado Senate Bill 23-144, titled “Prescription Drugs for Chronic Pain.” This bill was introduced in early 2023 to address concerns about the ability of health-care providers to prescribe opioids to chronic pain patients without facing disciplinary action if they followed medical need rather than arbitrary dosing thresholds.
Key provisions: The law allows health-care providers to prescribe, dispense, or administer Schedule II-V controlled substances for chronic pain. Providers are protected from disciplinary action solely for exceeding certain morphine milligram equivalent (MME) dosage guidelines, as long as the patient is stable, compliant, and not experiencing harm.
Other protections: The act prohibits forced medication tapering or denial of treatment based solely on dosage, and prevents insurers, pharmacies, and related entities from refusing to fill or approve coverage for prescriptions based mainly on opioid dosage levels.leg.colorado+3
Signed into law: Senate Bill 23-144 was passed by the Colorado legislature and signed by the Governor on May 4, 2023—it is currently in effect as Colorado state law.corxconsortium+3
Impact: Providers prescribing opioids to chronic pain patients are protected from disciplinary action as specified in the bill. The law remains active and part of Colorado’s efforts to balance safety with adequate pain treatment.nocomedsoc+3
In summary: The bill you referenced was successfully enacted and remains Colorado law as of August 2025, supporting practitioners like physicians and pharmacists in responsibly managing chronic pain patients with opioid therapy.
Improved Access: Senate Bill 23-144, effective since May 2023, was designed to shield chronic pain patients from arbitrary dose limitations and forced tapering solely due to morphine milligram equivalent (MME) thresholds. Health-care providers are now protected from disciplinary action if they document and justify higher dosages for stable, compliant patients. Pharmacies and insurers cannot refuse to fill prescriptions simply due to dose levels.leg.colorado+5
Real-world effects: Reports and commentary from practice leaders, medical societies, and policy analysts suggest the law has led to a noticeable improvement in the ability of chronic pain patients to obtain necessary opioid prescriptions. Providers can now more confidently prescribe opioids at clinically appropriate levels, reducing discontinuations and risk of inappropriate forced tapers.nocomedsoc+3
The law is regularly cited as a model for protecting patient rights and supporting practitioners, though advocacy groups and medical societies encourage continued vigilance and education to ensure its full benefits are realized.coloradopainsociety+3
DEA activity: There is no evidence that the DEA has targeted or raided Colorado practices solely for issuing high-dose opioid prescriptions to chronic pain patients since SB 23-144 took effect. Colorado’s law firmly states that providers who prescribe according to medical need and proper documentation cannot be disciplined based solely on dosage.leg.colorado+2
DEA nationwide actions: While the DEA continues to combat opioid diversion and has taken action against pharmacies, telehealth companies, and practitioners across the U.S., these cases typically involve clear evidence of fraud, illegal distribution, or gross violation of prescribing standards—not legitimate pain management under laws like SB 144. There have been pharmacy burglaries and sweeps for illicit activity, but no Colorado-specific reports indicate intimidation or raids against compliant practitioners.dea+2
Federal mandates: New federal requirements (as of June 2023) require practitioners to complete opioid safety and addiction training for DEA registration renewals, but these do not restrict the ability to prescribe chronic pain medications if compliant with state law.samhsa+2
In summary:
Colorado’s SB 23-144 has generally improved the situation for chronic pain patients and legitimate prescribers, allowing for better continuity in pain management and eliminating arbitrary dose caps. There are no reports of ongoing DEA intimidation or raids against Colorado practitioners acting within the law. Policy analysts and medical experts recommend vigilance and proper documentation, as well as ongoing provider education, to preserve safe access for chronic pain patients under both state and federal regulations.cato+4
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Just think about it! Kennedy’s MAHA is being diametrically opposed by the DEA/DOJ’s agenda. How many chronic pain pts get a “good nights sleep”? People who do not have a night of “restorative sleep” are not the healthiest people in our society! All those chronic painers – with under/untreated pain, often are thrown into Addison’s disease from all the extra cortisone that their body demands from the adrenals, until they fail from constantly running at 110%+.
How many chronic pain pts have been put under house arrest, because of their untreated pain? Not able to do much daily self care, and forget having time & energy to do creating some “healthy meals”, let alone many chronic painers are struggling financially and don’t have the financial resources to buy the “more healthy food”and have a more healthy diet?
Maybe Sec Kennedy needs to have a serious talk with AG Bondi and the decades old WAR ON DRUGS AGENDA and how it is having a negative impact on the QOL on 25%-30% of our population.
This is suppose to be Sec Kennedy secretary email OSA11y@hhs.gov
If you are one of those infamous “keyboard warriors”. Whining, bitching and moaning to each other in numerous FB pages… has it help you with your pain management ?Maybe it is time that Sec Kennedy hears from you and how AG Bondi & DEA agenda is compromising your ability to even contemplate trying to be part of a MAGA movement.
Pres Trump is bringing all the troops together to round up a lot of bad guys and illegals. Maybe he needs to federalize all those federal prosecutors, give them a bullet proof vest, a badge and a gun and they can go out and help all of our law enforcement. Maybe we can change the meaning of when attorneys say “they are bringing the rain”. Maybe be more effective than interfering with the practice of medicine and depriving chronic pain pts of their medications and trashing their QOL.
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Picture this: The FDA has approved a C-III med for POST SURGICAL PAIN, but farther down the article the company is talking about using it to treat high acuity chronic health issues
The company noted that it hopes to expand ketamine development into conditions such as Parkinson’s disease, amyotrophic lateral sclerosis, depression, and complex regional pain syndrome.
I can sense that the DEA is going to be watching this expansion of the use past acute post surgical pain. I can remember when Talwin, Stadol, Ultram came to market as a non-addicting med for pain, and it wasn’t long that all three were a CONTROLLED SUBSTANCE.
Then there was Lyrica – a gabapentin class of med – and I was told that 1 or 2 people in the clinical trials stated that it “made them high” and DEA could let that go by without some action and made it a C-5 Controlled Substance. Adding Lyrica as a C-5 increased the total number of C-5 by abt 20%, because there are so few C-5 meds.
There is little info on this “new med” but all the rest of the Ketamine based meds is injectable. With some pharmacy compounded nasal sprays and sub-lingual/buccal trochee.
I also have “the sense” that this medication may well end up being distributed thru restricted distribution via “specialty pharmacies” , which tend to be FAIRLY EXPENSIVE MEDS. Fairly expensive meds that are being promoted in treating high acuity chronic health issues, most insurance companies won’t want to pay for them.
https://www.medscape.com/viewarticle/fda-okays-ketamine-based-med-post-surgical-pain-2025a1000la0
The FDA has approved the racemic ketamine product known as KETARx (PharmaTher Holdings) for the treatment of post-surgical pain.
“This historic FDA approval…is a testament to years of dedicated development,” Fabio Chianelli, chairman and CEO of PharmaTher, said in a release.
“We remain steadfast in our mission to harness the pharmaceutical potential of ketamine for a range of mental health, neurological, and pain disorders,” he added.
The company noted that it hopes to expand ketamine development into conditions such as Parkinson’s disease, amyotrophic lateral sclerosis, depression, and complex regional pain syndrome. Its product has already received an orphan drug designation for the treatment of Rett syndrome.
It added that, among psychedelic and “psychedelic-adjacent” drugs, ketamine is the only one to be included on a list of Essential Medicines by the World Health Organization.
The company initially announced that the FDA had set an approval goal date of April 2024 for KETARx. However, after “minor deficiencies identified by Quality” were identified, the FDA assigned a new target date of October 2024. As reported by Medscape Medical News at the time, the FDA issued a complete response letter requesting additional information on the application.
The final date of August 2025 was set after the company submitted the requested additional information.
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I am current working with a young woman/Mother who is a intractable chronic pain pt and her pain doc without any discussion reduced her opioid OF TEN YEARS from 15 mg QID to 5 mg BID and put a her on a Buprenorphine Transdermal Patch which threw her into a SEVERE COLD TURKEY WITHDRAWAL!
Her blood pressure the next day was 240/120. I suggested that she take the patch off and BP dropped a little but still in the hypertensive crisis level. Tonight it is 230/103 and per pain level is 8+.
She is on traditional Medicare. I went looking to see what pt advocacy Medicare Part B has and this is what I found out. I also looked at what may be available for Medicare-C (Advantage)
Should pts start putting their insurance company or some advocates “feet to the fire”. After all, the insurance companies are being paid monthly premiums – by someone – and supposedly most of these insurance companies claim that they have a large number of contracted practitioners to take care of the pts that are policy holders.
The FDA released this statement LAST WEEK: The FDA is now requiring that opioid labels emphasize the importance of avoiding rapid dose reduction or abrupt discontinuation in patients who may be physically dependent on opioid pain medicines, as it can cause serious harm.
Maybe pts should tell their insurance company that if they can’t help you find a practitioner that will help manage their pain. They will go to the ED EVERY DAY and ask to be admitted.
Maybe if they “blow you off “, perhaps talking to a reporter about how you insurance company wants your monthly premiums but doesn’t have any contracted practitioner that will address/treat your health issues.
Traditional Medicare Part B does not directly provide or cover the cost of hiring a professional patient advocate, but beneficiaries have access to advocacy resources and support services through federally funded programs and organizations.patientadvocatesofswfl+2
Medicare Beneficiary Ombudsman: Medicare maintains an Ombudsman office that resolves beneficiaries’ issues and provides guidance on rights and protections. You can access this help by contacting Medicare directly at 1-800-MEDICARE.medicare+1
State Health Insurance Assistance Program (SHIP): SHIP offers free, unbiased Medicare counseling and advocacy about benefits, enrollment, coverage problems, and appeals. These services are available in every state, including Indiana, and can be reached at 877-839-2675.medicalnewstoday+2
Nonprofit Organizations: Groups like the Patient Advocate Foundation and the Center for Medicare Advocacy offer personalized assistance for Medicare eligibility, coverage issues, appeals, and understanding benefits, often free of charge.patientadvocate+3
Although traditional Medicare Part B lacks a dedicated, covered patient advocate service, these agencies and programs offer substantive help for beneficiaries navigating coverage and resolving problems. However, hiring a private patient advocate would require out-of-pocket payment, as this is not a covered service under Original Medicare. If you need personalized advocacy, consider contacting SHIP or nonprofit organizations for guidance and support.retireguide+1
Medicare Advantage (Part C) plans—unlike traditional Medicare—are offered by private insurers and must follow Medicare rules, but each plan may include different additional benefits and supports beyond standard coverage. Here’s how patient advocacy works with Medicare Advantage:
Medicare Advantage Plan Supports: Many Medicare Advantage plans now cover patient advocacy services, such as care coordination and help navigating claims or appeals. This coverage has expanded especially since 2024, making patient advocates—such as those from organizations like Solace—accessible to beneficiaries at little or no out-of-pocket cost. The specific benefits and coverage may vary by plan and region, so it’s important to check your plan details or ask your insurer directly.solace+1
Case Management & Grievance Processes: All Medicare Advantage plans are required to have clear processes for handling patient grievances, appeals, and complex care coordination. If you have a complaint, need to appeal a service denial, or require help with care planning, your plan’s customer service or case manager is your first point of contact. These supports are mandated and may feel similar to an advocacy role, but the individual still works for your insurer, not independently for you.in+1
Independent and Nonprofit Advocacy Resources: Like with traditional Medicare, you can turn to independent nonprofits—such as the Patient Advocate Foundation and the Center for Medicare Advocacy—for personalized guidance, advocacy for appeals, and education about your rights. These organizations assist all Medicare beneficiaries, including those in Medicare Advantage plans.patientadvocate+3
State Health Insurance Assistance Program (SHIP): SHIP counselors provide free, unbiased help to Medicare Advantage beneficiaries, including help with plan benefits, grievances, and appeals. This service remains available regardless of which plan you have.cms
Summary Table: Patient Advocacy with Medicare Advantage
| Resource | Type of Support | Cost |
|---|---|---|
| Plan Case Manager | Claims, appeals, care coordination | Included in plan |
| Nonprofit Advocacy (PAF, CMA) | Personal assistance, education, appeals guidance | Usually free |
| Solace Advocates (2024+) | Hands-on advocacy, care coordination (select plans) | Often free/covered |
| SHIP | Unbiased counseling for all Medicare options | Free |
| Hospital/facility advocates | Bill and care issues during hospital stays | Included |
Medicare Advantage brings additional advocacy options, especially since 2024, but the availability and cost depend on your plan and local resources. For more personalized advocacy, reach out to your plan, SHIP, or independent groups for support with billing, appeals, or understanding your benefits.patientadvocate+2
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