- Posted January 12, 2013 by
This iReport is part of an assignment:
Photo essays: Your stories in pictures
Proof of What's to Come with Obamacare in my Letter to Humana
The TRUTH about Obamacare's affects in my recent letter to Humana...
My name is Timothy ___________ and my member number is CONFIDENTIAL. The very polite agent with Humana’s Prescription Grievances and Appeals recommended I provide as much information as possible in this letter. In the Humana agents words, “Short and sweet will get you nothing.” To make this appeal as easy to follow as possible, I have laid out this appeal in a sectioned format as follows;
Humana’s Blatant Discrimination
A Quick Lesson on Pain
My Medical Need
Why Would you do This?
A little back-story before I really get into the meat and potatoes of this letter, Humana’s repeated discrimination against chronic pain patients, and in this case I speak of myself. It all started several months ago when a sloppy Walgreens pharmacist neglected to tell me that Humana denied my Suboxone 8mg sublingual (SL) tablet prescription. What a surprise right? I’ve only been on the same medication... for the same problem... since 2005. I take the medication for a problem that is not going away, though I have explained this to Humana, my pain specialist (one of the top in town) has explained this to Humana, and I can only come to the conclusion that all of your experts cannot grasp the fact that I am stuck with terrible chronic pain for LIFE...
Regardless of this terrible condition I must live with, Humana continually throws stumbling blocks before me, and I don't believe it will stop.
In the case of the 8mg tablets mentioned above, I used my express pay (Walgreen's charges the credit card on file), and later that evening noticed my receipt had a charge for nearly $800. I was in shock, I’m on Federal Drug Assistance and that essentially means I’m indigent, it wiped me out. My only means of survival is Social Security Disability, an entitlement granted by the Federal Government to help people like me, and the Walgreens clerk had to realize the financial devastation an unplanned $800 charge would cause me. It states the amount Federal Drug Assistance covers right on the receipt, the clerk had to notice this... or he just didn’t care. I have been all over Walgreens, I even resorted to posting my story on their Facebook page, and though I finally heard from a district manager... they are yet to accept any responsibility for their pharmacists sloppiness.
Let’s talk about the devastation this has caused me briefly, though it is apparently of no concern to Walgreens, Walgreens upper management, or Humana. I am now over a month over-due on rent and facing eviction in the NEXT WEEK. My children got to watch their cousins and other friends open Christmas presents as they opened nothing. Granted, I'm sure $800 doesn’t seem like a lot to you. When that’s all you receive every month in SSDI and the state suspends your food assistance for a trivial stipulation... it can trash your family’s life.
I think the part that I am happiest about is that I have endured; I have remained polite and respectful on the phone with unhelpful Humana agents, a confused receptionist at my pain doctors office, and the completely disrespectful Walgreen’s pharmacy employees at the 44th and Wandsworth location in Wheat Ridge, CO. This is my life... without the pain medication I have no life, and I have been paying out of pocket for for my current pain meds because Humana still fails to recognize medical need. I’m running out of money and cant fill any more partial pain medicine refils, I can’t pay my rent, I can’t put food on my family’s table, and it is 100% because of Humana’s policies towards their patients... I don’t know what else to do.
I'm a student on social security disability... I HAVE TO continue buying pain meds three or four at a time. How do you suppose I do this? On the other hand things are just peachy for Humana, how did your P&L look this year? I’ll tell you what, my families P&L is trashed, and its because of your company’s continued discrimination against me, and I’m sure millions of others in chronic pain.
Humana has me between a rock and a hard place. I lay in bed screaming when I don’t have my pain medication, with Suboxone I am the head copywriter (press releases) and head photographer for a top national community college, of course I will bleed my bank account one partial refil at a time as Humana continues to pretend they do not understand chronic pain.
I understand Obamacare has stripped Medicare, I get it... you guys are worried about the bottom-line, and why not attack pain patients first right? Pain is something that cannot be seen, to Humana’s continued benefit it is something that cannot be proven, but I feel it all the time and it is hell without the proper medication... Not to mention that the medication I’m on is something one cannot just “stop” without serious repercussions. Humana has me standing on my head for their amusement.
Humana’s Blatant Discrimination
I have been on Suboxone 8mg sublingual tablets for almost eight years. The medicine works for me and allows me to live a normal life. Humana has constantly denied this medication throughout the course of my treatment. The nice agent on the phone with Grievances and Appeals said herself, “Well... there are several denials here, I will have to read through them, bear with me because this will take some time.”
I just sighed because I was aware of every denial. Each time my doctor or the pharmacy says, “Insurance denied it,” my heart skips a beat and I start to panic. I immediately fear that I will become debilitated, even if temporarily, and lose the job I love so much (head Copywriter, Photographer, and Videographer for Red Rocks Community College). Without pain meds I will fail my classes for attendance reasons and destroy my family and home life because I’ll be impossible to be around. Everything I have endured, the insurmountable odds I conquered, and the betterment of my life through higher education will all be ripped away from me.
You don’t understand how this feels because you don’t care, but I will tell you it is hell and each time I fear whats happening with my pain medication years are removed from my life due to stress.
Sometimes the insurance denials are for something simple like an annual pre-cert. Other times Humana flat out denies the medication for other reasons like medical need. I will address my medical need in section five but for now lets pretend that a highly qualified pain management specialist has been addressing each denial and stating that I had a serious medical need for the medication. Let’s take it a step further and say that the doctor even wrote the script in a way that it was not only for pain management but addiction.
We don’t have to pretend because that is what happened. Each denial was addressed by my pain management specialist, he even went as far as calling me an addict to get the prescription approved, and he felt horrible too because he knows I am far from an addict and take great pride in that. The sick part is, after he added that the medication was for addiction, Humana covered the drug. Mind you this was four to five years after I began taking the medication.
Its a nice racket you have going. Make people who are already demoralized, ostracized, and stigmatized by society, the chronic pain patient, self-describe as drug addicts before “allowing” their prescription to be covered. I cant speak for others, but it made me feel absolutely horrible. For twelve years, I refused the narcotics and I endured eight failed spinal surgeries because I am not an addict. I am a pain patient; and when the prescription was once again covered by Humana... it made me sick we had to use "addiction" to get it covered.
Why even call us pain patients? Just call us drug-seekers. In 2010 the Army Surgeon General stated (after 12 months of intense research), “The failure to address chronic pain in the health care system has lead to unnecessary suffering, exacerbation of additional heath problems, and untold financial and personnel costs.” Google “Pain Management Task Force” to read the report yourself. The Army Surgeon General estimates there are 50 million chronic pain patients in America and Humana is part of that health care system that fails them. I don’t have to tell you what Humana’s blatant failure to reasonably address my chronic pain has done to my life, the Army Surgeon General just did.
A Quick Lesson on Pain
Chronic phantom nerve pain was first addressed, albeit accidentally, by the great philosopher Rene Descartes in the 1600s with mind body dualism (http://www.unc.edu/~wkidd/phil.htm). An aristocrat challenged Descartes philosophy using one example, phantom nerve pain, and Descartes’ only defense was that some things are in god’s hands. As a sufferer of extremely severe chronic phantom nerve pain, I can say with full confidence that phantom nerve pain is not from god... it is from somewhere much “lower.”
A civil war military surgeon and neurologist named Mitchell was the man who gave phantom nerve pain. A fitting name because I liken what I endure to phantoms and demons infesting my entire leg all the time. Go look up Mitchell yourself if you need to, I’m just trying to make this complete as possible as the Humana agent suggested.
For twelve years I heard two things from medicine. Ninety nine percent of the physicians out there told me, “There is nothing that can be done you must learn to live with the pain.” The first time I heard that I was going seven to ten days without sleep during attacks... and there were several attacks per month. The other thing I heard was, “This is the only thing that can help you and we just need to give it another shot.” The pain clinic at CU Medical were big proponents of the Medtronic Neurostimulator. CU Med was able to cut on me eight times, each time with a promise the next surgery would work, and CU’s constant dissuasion convinced me that neurostimulation was my only option.
My Medical Need
In fact, CU Medical greatly misled me, and their knife was not my only option. Suboxone, a drug that was around long before my accident, cut my pain in half within one week. I sure hope that CU Medical got some great kickbacks from Medtronics after all the lies they told me about the Neurostimulator because I went though hell over their insistance nothing else would work. It confused me because I saw other patients with pain pumps and other options in the CU Med waiting room all the time.
See, I didn’t want to take pain medication in the first place. I allowed myself to be butchered by CU Medical eight times within 12 months. I believe thats illustrates my position on pain meds pretty clearly I always insisted that I would not take a tolerance building narcotic no matter how well it worked. Check your records Humana... I am on half the dose I was 8 years ago when I began taking Suboxone. What saddens me is the group at CU Medical represented themselves as pain management specialists, If several other pain management specialist (that I met later) knew of Suboxone’s effectiveness with chronic phantom nerve pain, the “specialists” at CU Medical should have known (and probably did) of Suboxone too.
Instead of options, I was offered a ninth surgery with promises that the ninth surgery would finally be the one that worked. My primary care physician put a stop to it after a post-surgery exam when she said (referring to CU Medical), “My god... they are treating you like a human cutting board."
Her exact words. I could not speak, tears welled in my eyes, and I was well aware how CU Medical was treating me; what other option did I have? Argue with the professionals, tell them that a Medtronic device was not my only option, and subsequently be accused of drug seeking? I already went down that road and its a big part of why I refused narcotics for twelve years. I learned very quickly that when one is in extremely severe chronic pain, their own opinions and feelings become irrelevant, and if the patient doesn’t understand that... a drug seeker accusation is the next step in correcting the patient’s misunderstanding of how things work.
I only mention the neurostimulator to illustrate my dedication to solving phantom nerve pain without pain medication the rest of my life, not to save Humana’s bottom-line, but instead to save my life. Ask yourself, would you subject your spinal cord to eight surgeries within 12 months, including two extremely invasive proceedures, to avoid taking pain meds? Well I did...
The last thing I want to do is call myself a junkie to get Humana to cover my meds, but you have me where you want me, and I had no other choice. To get my pain meds approved by Humana there is always a new hoop to jump through, my only option was to label myself as a addict to have my PAIN meds covered, and I did it though its against everything I stand for. Furthermore, that "addict" label will probably haunt my medical records for at least seven years. all because your experts question my pain management specialist every three to six months. That’s really low to do to someone, especially someone who lives in hell every day but still shows incredible strength and makes it to his feet every time... no matter how bad it hurts. Humana's behavior is despicable.
I have made something of myself despite constant torture. Between work or school the people who meet me cannot believe that I still press on when they see how bad the pain really is... WITH the medication. I have done amazing in college and my press releases for Red Rocks are printed in the Denver Post almost weekly, verbatim with no editing, because I push past the pain. I am thanked for this strength every three to six months, as the only thing that has given me any quality of life in 17 years, suboxone... is dangled in front of me like a carrot by Humana.
Why Would you do This?
I go through hell just getting out of bed every morning, but I get out of bed, and despite that I have made something of myself. Every six months or so... YOU threaten to take that achievement against insurmountable odds away
Your agent recommended I supply as many medical records as possible. I was thrown from and crushed by a 3,753 pound GMC pickup truck at OVER 100 miles per hour in 1995. Since then I have lived in hell. Is that what you mean by medical records because I’m really not sure what you want other than to jerk me around some more.
Apparently a pain management specialist’s repeated explanations... for YEARS are not enough. Your “experts” need to see my medical records now, for what? Its obvious they have no understanding of chronic pain though they feel they know better than a pain management specialist. Tell me what medical records will accomplish? Will I get my prior auth and be reimbursed the $800 for the suboxone 8mg tablets? Will I get a prior auth and have all this buphenorphine I have had to pay out of pocket for since then reimbursed? Oh, and what about my current prescription. That is also currently being denied... just a simple fix?
Even if I’m reimbursed for the suboxone from months ago, that doesn’t cover all the interest that has accrued over the last 3 months or so, and what about the snowball of debt that has accrued since then. So, even if I take care of the $800 from months ago, even if I get reimbursed hundreds of dollars for the pain meds I have paid out of pocket for since then, I still have to fight for my current meds.
If it is fianlly approved it will only be for three to six months until Humana again discriminates against our nations most tortured patients, the extremely severe chronic pain patient, and yet another prescription for my pain medication is denied as your experts fail to understand why someone in extremely severe chronic pain would need to take pain medication.
You have put me on a roller-coaster for years over pain meds. Humana has acted despicably in handling my prescription requests, “Let’s get him to call himself a drug addict before we give him his pills. It will be great, either his pride wont allow him to do it and Humana saves money, or we get to laugh at our little self-depreciating trained monkey until we deny his meds again in six months.”
What you are doing to people like me is sick.
If you are interested in how I am fighting chronic pain as a seventeen year survivor please view my recent Photojournalism final in video format: http://www.youtube.com/watch?v=5mwF-KUXn2I