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Patient: Paula Ducas
Aug 9 2002

Dr. Hochman,

I don't know if you will be able to help me, but you look like the best hope I have.  My mother suffers from chronic pain - and has for at least 17 years.  A pain that hinders her day to day activies and has caused her to become depressed and suicidal at times.  She had tried nearly every treatment she thought was available - until June 2002.  In June, she was referred to a pain clinic in Kalamazoo Michigan which treated her with a Lidocaine Infusion.  She suddenly became a different person, able to run up and down stairs and perform other daily activites free of pain.  It was the first time in 17 years she had been pain free.  The issue at hand is that she moved to Hawaii in July 2002 to be near myself and her two grandchildren in order to see them grow up.  She was initially told by her new insurance - Kaiser Permanente - that the infusion was a covered procedure, but was then told that she would be r! eferred to an anesthesiologist who would review her case and "decide" if she "needed" the procedure.  She has now been told that they don't do the infusion at all because it is "too risky".  Personally I think it is "too risky" to deny my mother a treatment she knows works and risk her taking her life.  She does not have the luxury of having enough money to fly back to Michigan and pay for the procedure every month, and she is at her wits end.  I don't feel that someone should be able to deny her a positive treatment because they don't feel it is worth the risk.  It is my mother's body and she should be able to decide what is worth the risk or not.  As far as we can see there is not a single doctor in Hawaii that will perform this procedure.  As I said I don't know if you can help, but I thought I should at  least try every avenue I can find.  I don't want to lose my mother because no one is willing to "risk" helping her.  Please t! ell me if you have any suggestions as to how I might get help for my mother.

Sincerely,

Paula Ducas
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Dear Paula:
Most HMOs have an appeals mechanism, required by law. Inquire at Kaiser and appeal. Assemble all your Mom's medical records, detailing her previous treatment and the successful outcome. Appeal on the basis of medical necessity and "demonstrated effectiveness". Also threaten to call up JCAHO to report their failure to adhere to the pain treatment guidelines adopted in June of 2001.  Join NFTP.  Keep us posted.  Dr.H

This article is permanetly stored at: http://web.archive.org/web/20100109083408/http://www.paincare.org/pain_management/correspondence/patient_
letters/show.php?id=668


It was stored at: http://www.paincare.org/pain_management/correspondence/patient_letters/show.php?id=668









 

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