Question: My PCP told me he received a letter from my insurance stating concern over the amount of narcotics I consume?
Here’s a little break-down: I have had 3 different cancers, 15 surgeries in relation to said cancers, 6 months of chemo, radiation, MS, and massive chronic pain. I have been put on Vicodin numerous times over the last 4 years. I managed to get myself off of Vicodin until my most recent (and most horrific) colon cancer surgery. I willingly went back on it, but in the last 8 months of recovery, I’ve had a lot of complications (which means, a lot of pain). Two weeks ago, I went to my PCP, told him I wanted to start weaning myself off the stuff, I asked for a lower dosage, and he simply said to break the pills in half.
Today, according to my prescription bottle, I am “due” to get a refill. However, I still have 35-40 pills left. The irony in this is that I had called PCP to inquire about something totally not related to Vicodin, and he responded, “I have a letter from your insurance saying they are concerned about the amount of Narcotics you are taking.” I said, “Wha?” After a moment of stunned silence, I told him I take what he prescribes, reminded him I asked for LESS, and said, “I’ll tell you what I have been saying to all of my doctors for the last four years. Find the reason I have so much unbearable pain once and for all, fix it, and I will gladly agree to NEVER EVER EVER take a pain med again.”
Here is the weirder thing. I immediately called my insurance to confront them. They searched every department, every person, every paper, you name it. They have NO record of sending a letter, and the rep had said, “That doesn’t even sound like something we would write, anyway!” She told me to ask my doctor to fax this letter to her so they could try to track it.
I also called my pharmacy. They know very well the struggle I have with juggling my many medicines, have been very good at catching interactions, so I wondered if they were the culprit.
“Nope. We don’t send those.”
My question is, WHAT THE HECK?!?!?!?!?
Thank you in advance for your help.
sarah314-your answer is awesome! One question based on that: I had called the insurance rep first, she checked automated letters first, looked into my general notes second, and LAST, she did call the PBM who said there was nothing, either. That did get me to wonder one bizarre thing, though. I changed cell phones and never updated my number with them (just got an angry letter from them demanding I call to authorize one of my meds). Is there any connection, do you think?
maybe it was a remark made in passing.
They may have sent a letter to your doctor questioning his prescribing habits, checking for documentation to ensure that he isn’t over-prescribing narcotics to people.
A letter like that would come out of a medical or utilization review type department, and any file copy regarding it would be referenced under your physician’s name in the UR department. (Its not something that would be tied to your file, because they’d be questioning his prescribing habits…not your consumption habits.)
One other thing…did you call your health insurance company or your pharmacy benefits manager (PBM)? If you called your health insurance company, they wouldn’t have any information related to what your PBM sent out anyhow. Technically, your PBM is your “insurance” for prescriptions, and it would be *their* utilization review department that such a letter might have come from.
(Common PBMs include Medco, ExpressScripts, Caremark, etc…check the insurance card you use for prescriptions. Quite likely, it mentions one of those companies or another PBM.)
Honestly, I wouldn’t worry about it TOO much if I were you. If such a letter actually was sent, it quite likely was just asking your doctor for justification as to his prescribing habits. If he has a pattern of prescribing lots of narcotics to patients, they might just want him to justify that. But again, its not something that should affect you personally – again, its likely the doctor’s judgment they were questioning yours.
P.S. It doesn’t meant there’s anything “wrong” about your doctor either. If he treats a lot of patients with severe pain, he justifiably could be prescribing higher than typical amounts of narcotic meds.
