PHARMACIST STEVE

Hi Steve,

I found your article, dated 2014. Much has evolved since then regarding opioid medications. I wonder if you can offer me some guidance..

My new insurance company (Medical Mutual) has just denied my regular pain medication, Hydrocodone — which I take for a myriad of painful disorders, including a rare central nervous system disease which distorts my body and causes spasms in muscles, organs, lungs. My medical records span 30 years: I see 7+ doctors on a regular basis. There is abundant medical evidence of my chronic, severe, incurable pain.

I called the insurance company and was told, “A pharmacist has signed off on this.” They would not give me the pharmacist’s name.

My questions:

Am I entitled to a copy of this denial? (These insurance premiums are paid by my husband and his employer!)

How can a pharmacist decide what is best for a patient without reviewing medical records?

What can I do? How do I fight for myself against an all-powerful insurance company?

I have been on social security disability since 2006.

Thanks in advance,
So one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy – especially medication…  So apparently this “Pharmacist”  at this particular insurance company has self-anointed his/herself with the legal authority to change/deny a pt’s long term medication therapy. or someone at the insurance company (Medical Director ?) has given others the authority to practice medicine under his/her license ?

There are so many people within the health care industry that are bending/breaking all sorts of rules/laws… and all the authorities who are suppose to be upholding these various rules/laws are turning a blind eye to what is going on… 

Have you ever notice that on some roads where speed limits are poorly enforced… that fair number of drivers routinely driving way past the speed limits ?

Human nature being what it is… if people do things illegal without any consequences… they will continue down that same path or maybe expand the areas in which they break rules/laws… until some time that there are consequences

Filed under: General Problems