Hi, I'm new here. Need a place to talk...

Garbage insurance. currently I have BMC Health. Switched from MassHealth. (Both are State funded) Prior to that, I had Harvard Pilgrim through work. With state insurance, you clearly get 2nd rate care, in most circumstances. Not what you want with a complex issue. Fine if you have the sniffles though. My Harvard Pilgrim family plan was about 1,400/mo. Part of the reason I want to work for an insurance company, writing estimates, is because of the discounts. Its substantial.

No problem Mike, like I said we just have to keep it clean here at the forum.....Susie

Mercy&Grace my experience has been you must have a dx in order for the dr to justify rxing pain meds. Anyone can walk into a drs office and say I hurt here or there but does not mean you will walk out of there with a script in your hand......Susie

This is where a pain mgt dr comes into play. Primary care drs do not want to rx pain meds long term because they do not want to jump through the hoops they would have to since the DEA became involved. Sometimes people even have to drive a little farther to get good care. If the dr is good he is well worth the extra distance........Susie

We have had many members here at the forum on Medicaid and they were/are seeing pain mgt drs, . This is the first I have heard of this. Can you tell us what states are doing this? You mention Medicare doing the same can you tell us when this will go into effect with Medicare and what states will be involved? Thanks...Susie

I can only speak for Maine because I do have MaineCare (medicaid) as a secondary insurance.

Mainecare will only cover a 15 day script for narcotics for a lifetime total of 45 for non cancer or aids pain. However that being said yes mediciad will not cover the script but you can still have a presciption written and can fill it at your pharmacy and pay for it yourself. However if you carry your own private policy and have Mainecare as a secondary, mainecare has to follow your primary insurance plans rules on coverage.

I don't think the issue is that someone recieving medicaid has a harder time recieving a narcotic script for non cancer pain. Its just what will be covered and what won't be. And as long as you follow your doc's orders and pain contract, your doctor doesn't care if you use insurance to fill your script or pay cash.

Susie, I'm sorry it took me so long to get back to this.

First, I'm referring to when someone has Medicaid only. If Medicaid is their secondary, the situation is different because the primary covers the majority of services. And if Medicaid won't pay for something if that the only insurance you have it won't pay for something if it's your secondary. I'm also referring to chronic pain that is not cancer related.
Louisiana is one state that I'm sure doesn't cover Pain Management. It states it in their Provider Manual for Medicaid.
Regarding Medicare, I was referring to the increased oversight of the providers who write rxs for those who have Medicare Part D. The oversight is basically the same as with Medicaid. The providers have people overlooking the rxs they write that are from the different drug plans. And this is in addition to the ones they are use to like the Prescription Drug Monitoring Program
. The argument could be made that a dr can write a rx for whatever they want to. And this part is true, but if a patient receives Medicaid and/or Medicare the dr will have to deal with health plans or drug plans questioning what he writes, the dx, how much, etc, and if changes the sponsors recommend aren't used, the drs payments could be effected. Some drs may have the extra time to spend talking with someone from these plans regarding how they treat a paitient and why, not to mention the extra paperwork involved. And some drs may not have a problem with someone who isn't a physician telling them what they can and can't prescribe and how much, ect. But the majority of drs will either stay away from rxing pain meds for chronic non cancer related pain or stop seeing Medicare patients all together.
Medicaid is based more on state choices, so the states in the north won't be as restrictive as the ones in the south. Medicare is not like this and is uniform were Medicaid is not. I've put some links at the bottom.

Drug Diversion in the Medicaid Program-January 2012
https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf

Additional Guidance Related to Improving Drug Utilization Review Controls in Part D-June 29, 2012
http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/OverutilizationFurtherGuidance2013.pdf

State of Louisiana
Bureau of Health Services Financing
Professional Provider Services Manual, Chapter 5 of the Medicaid Services Manual, Issued February 1, 2012

"Louisiana Medicaid does not cover any services for chronic pain management." "Chronic pain management is not a covered service. Funds reimbursed for this purpose are subject to recoupment"

Just a thought. I wonder if its covered because its not being written up as chronic pain, but as ie a spinal condition or such.

Now I may be wrong but I imagine there is also a way to get preauthorization for some procedures that could be done.