CBS 2's Paul Moniz reports there's a new survey about people living with chronic pain that shows more than half are dissatisfied with the care they receive.
The study, conducted by Pain.com, reveals pain patients see an average of 7.2 doctors about their condition. Some of their biggest complaints are that doctors do not take their pain seriously and, even worse, that many of their medicines are not covered by insurance.
"You don't think that your insurance company is going to turn around and slap you in the face and say, 'Guess what, pay for [your medication] yourself because we don't insure it,'" complains Marjorie, who battles chronic, debilitating pain after a knee injury she sustained last summer. She is now fighting with her HMO.
At issue is coverage for expensive, cutting-edge pain medication.
The 49-year-old Long Island mother of two says her health plan has covered just three of her 15 prescriptions.
It stumps Marjorie and the millions of other chronic pain sufferers that technology has made effective therapies available yet insurance companies won't always pay for them.
"How dare [they] tell me what I can do with my life?" she says. "I'm trying to get better and [they] won't let me."
Doctors say the uncertainty over coverage and unrelenting pain can leave patients severely depressed.
"They become frustrated, they become hopeless, and it's kind of like a helplessness sets in," says Dr. Allen Lebovits of NYU Medical Center.
Bernedette Gannon knows the despair only too well. A bus accident left her with six screws and two rods in her spine. She pays $800 out of her own pocket every month to dull the pain because her health plan will not pay.
Bernedette's doctors wanted her to use a powerful pain patch but at $450 a month, she cannot afford it; so she takes something cheaper: methadone, which is the same drug used to treat heroin addicts.
The side effects can be sickening.
"Ringing in my ears, difficulty with dizziness, nausea," she says. "But at this time, it's all I can take."
Treating chronic pain patients is indeed a complicated problem.
Skyrocketing drug prices have left health plans scrambling to stay profitable. Few plans are willing to cover therapies on an open-ended basis. Bernedettte and Marjorie are forced to rely on samples from their doctors.
But health plan administrators claim reports of underpayment are exaggerated.
Dr. Charles Culter is chief medical officer at the American Association of Health Plans.
"I'm not aware of how large a problem this is and it's not something we've heard from the health plans," he says. "There are controversies about what's the most effective therapy."
Dr. Culter insists most patients get the care they need, but pain specialist Dr. Harvey Finkelstein disagrees.
Finkelstein has written countless letters trying to get medicines and surgical procedures approved. He complains health plans make som patients jump through hoops to get coverage.
"The biggest problem is you're always explaining everything four and five times," he says.
If you have a dispute over coverage, you can appeal directly to your insurer, or in some states, such as New York, to an outside monitor. The insurance companies say your chance of winning is about 50%. But because insurers tend to approve therapies for only short periods of time, you may be have fight repeatedly.
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