Who you gonna call?

It’s that time again, a time when “most” everyone who is in chronic pain wishes was easier to control, the dreaded medications refill.  I have gathered my fair share of stories on this subject over the past 23-1/2 years since I was rear ended causing major chronic back pain.  However I must say, I have never ran into this issue before.  With no further ado, here goes nothing.

August 21st, 2016 Drop my six prescriptions off at the pharmacy for refills.

August 23rd, 2016 Meet with Pain Management doctor to obtain monthly refill of my oral pain medication and dropped off at pharmacy.

August 23rd, 2016 Received call from pharmacy that the middle man, Tenisis Group is not receiving any call back from my workers compensation (Sedgwick) adjuster and after six tries, six messages and six no call backs are suggesting that I call them myself to try and speed things up.

August 23rd, 2016 I call my adjuster, Jack* and just as Temisis did, I receive his voicemail.  The difference however is I listened to it.  In his voicemail he clearly states, “from August 20 – August 28, he will be out of the office and if the call is an emergency please contact his associate at (925) 123-4567 of course this is not the actual contact number.  I then call his associate  and I obtain her voicemail.  This is the interesting part, her voicemail clearly states, “Hello, this is Kelly*, I will be out of the office from August 20 – August 24th and will return on August 25th.  If this is an emergency please contact my associate Jack* at the following number (925) 123-4567.”

 WHAT? WAIT A MINUTE, he’s on vacation or out of the office and his backup and her backup are also out of the office.  

One question comes to mind, “How is any of these adjusters clients suppose to get their medications, x-rays, therapy, etc. approved if their both out of the office and when I call the direct number all I get is a third voicemail asking for a voice message so they can get back to you?  I seem to have the worst time with getting medications approved at a rate of about 5-6 out of 10 times I am delayed in getting my refills on average 2-3 days and have had several that have gone as long as ten days.

The main issue here is about 3-4 years ago the pharmacy and myself were able to contact the insurance company directly if there were any issues, then the California Workers Compensation system decided to reduce the number of calls going into the adjusters that it would add a third party middle man (Temisis).  Now when a workers compensation claim is dropped off the pharmacy or even the patients doctor need to contact Temisis first with the request, then Temisis in turn contacts the claims adjuster and relays the request.  When the adjuster provides Temisis with an answer they (Temisis) then calls the pharmacy back with what ever the answer is.  If it is a “NO” or “More information is required” the process starts all over again.

How long do you think it took to get approval for a drug test?  Which if you have not been informed is performed on a random basis for all patients prescribed an opioid.  Yes, at any appointment you can be asked to provide a sample (in office) for testing and this is a Federal Law that was put into place about three months ago. Oh the answer, none.  The doctors office is provided a list of patients that are required to perform the test on their next visit.

As of this afternoon I have missed one dose of all medications, all pending a call back an approval through the pharmacy to fill my prescriptions.  This is one of the reasons that in our book, “365 Caregiving Tips: Practical Tips from Everyday Caregivers and A Journal of Care” we stress knowing what is happening with your medications, become friends with your pharmacist, they have a lot of pull with the adjusters when they need to, why because they know you and know the type of person you are.  Do you overuse or under use? Do you constantly ask for refills prior to the date?  They note these items in your file and I’m sure this makes it back to your adjuster.

To all of you who go through the same thing, here’s wishing you better days ahead.

“Pain Without Humor is Just Painful”

~ Richard Kreis