Many times patients do not feel comfortable asking questions. They may feel like the questions are silly or embarrassed for not understanding something so remain quiet. This is exactly the time to ask! Remember, any successful long term relationship is based on communication, which is a two-way street. You are expected and encouraged to ask any questions you may have.
Unfortunately, fighting pain can be a long process, lasting years. Not only can existing problems get worse, but new things can happen….things change! If we try to treat your pain with therapy, medicine, or intervention, and you don’t feel the benefit, let us know! Don’t give up! Many many times, pain can feel the same from multiple sites and we are only allowed to treat one site at a time. For example: if you have a car with a dead battery and out of gas, and I give you a new battery, your car is better, but you can’t perceive this as you’re still out of gas! This is the same as fighting pain. Many times we treat one area, only to find another area is symptomatic so there can be no appreciated benefit. This is why you should always follow up with us so we can update the evaluation and make sure you are heading in the right direction on your journey through pain control.
If you need a refill for a narcotic (controlled substance), you will need to be seen and evaluated within the last 1-2 months before we can refill your narcotic. If you have been compliant with your narcotics, such as expected urine drug screens, not asking for early refills, no self escalating your narcotics, etc, we will be able to refill your meds every two months. However, if we find there are some questions about your narcotics such as the examples above, you will need to be seen within the last month before we will refill your narcotics. Based on your compliance, when you are ready, simply call the refill line 3-4 days before you run out of meds to give us time to check your chart and verify you are due for your refill. We will then send it to your pharmacy. Based on our policies, If you have been seen in the last month, there is no need to come in...we will fax the prescription to your pharmacy.
3. Insurance companies control everything
Unfortunately, although there are many benefits to insurances, there are many downfalls too. Many times we will identify two or three areas of pain that need to be addressed, but your insurance policy will only let us address one area at a time. This is part of the pain treatment journey. We are often slowed down by insurance limitations. But don’t worry, we are dedicated to fighting your pain with you. We are constantly updating your insurance policy information and trying to get permission from your insurance to perform treatments. Just like you, we don’t give up. We will do as much as we are allowed by your insurance company.
We try to communicate our plans, expectations, rules, and plans with you every visit. We hope you communicate just as much with us! We understand life happens….things change. Other doctors are treating you with new medicines. Jobs have many limitations on booking appointments. Children need to be picked up/dropped off at school. Spouses get sick. Traffic and bad weather happen. Families have emergencies. Vacations are needed. People forget to call in for a refill. We understand life continues to go on while being treated by us. However, when these things happen, we expect you to communicate with us so we can document this in your chart and make changes accordingly. Many times we will still be able to see you. If not, we will communicate back with you so you can plan accordingly. Please communicate with us. It always makes things better.
5. Narcotics are used appropriately
Narcotics (opioids) may be a great option for some patients. Unfortunately, narcotic diversion (the inappropriate use of narcotics) is a national epidemic and consequently, all pain physicians are highly regulated. We frequently provide narcotics to help patients with their pain as narcotics do have some benefits. But we also educate our patients about the dangers of narcotics. We provide educational materials such as the REMS (Risk Evaluation and mitigation Strategy) to each patient when they get accepted into the practice so they can learn about narcotics. Once again, knowledge is power. We follow all the national guidelines concerning narcotics and treat our patients with long term goals frequently more important than short term goals. We provide each patient with a narcotic contract that specifically lists all expectations and rules following narcotics prescriptions from Dr. Moran. We provide patient expectations with information that lists what we expect from all our patients. We take random urine drug screens following guidelines based on patient risk assessment and many other steps are taken to ensure your safety and comfort, at the same time following the guidelines for pain physicians on a national level. There are many studies now giving high-quality evidence and proof that long term narcotics do not help your pain, but actually make the pain worse. We are constantly working with you to provide the necessary comfort when needed while maintaining your healths long term interest as a priority.
6. Before narcotics, let's consider non-narcotic medicines
There are many rules we follow regarding narcotic use..and a priority rule is to try non-narcotic medicines first! Therefore, before starting narcotics, we like to consider non-narcotic options such as anti-inflammatories, muscle relaxants, and nerve-calming medicines. Many times your insurance or guidelines will make us try non-narcotic options before we can provide narcotics. Even over the counter medicines count such as ibuprofen, Tylenol, and naproxen. We take a detailed history of all your previous treatment options so we can show we are following guidelines. Which leads me to my next point.
7. Paperwork is a necessity for your insurance to approve things
I know how frustrating it is to be given paperwork every visit and to be asked questions many times. These are not done to torture you! These are done as we know what it takes to get your medicines, therapies, and/or injections approved. Please be patient and work with us…we are trying to maximize your treatment and documenting information that is required by your insurance. The more information we have about your history and things you have tried, the better the chances we can something approved.
Many times patients think the physician is the one directing the visit and they must be submissive to the physician. We expect you to take control of your life! If at any time you are not happy with your treatment plan…just say so! We are constantly educating you about your situation so you can be an active participant in your health, creating a discussion with each patient about their options instead of patients just doing what they are being told to do and sitting quietly. We are here as consultants for you, we work for you. If at any time you are not happy, let us know. We want to keep you happy and involved in your treatment. You should never feel like you have to keep a physician. You should know if you are not happy with any of your physicians, you should find another one. There are lots of great physicians in San Antonio. You should feel all of your physicians are working with you; not telling you what to do.
We know you will have many questions that come up…even after a recent visit. Many of your questions can be addressed using this website or our FAQ section. Don't know how to get your refill? Check our narcotic refill policy. Not sure where your next appointment is? Check with the patient portal about the location of the next appointment. Not sure if you should fill other scripts from other doctors? Check our narcotic contract and policies. Lost or stolen scripts or narcotics? Refer to our narcotic contract for lost scripts or pills. What if you’re in the hospital and another doctor gives your narcotics? Our narcotic contract answers this too! Many of your questions’ answers will be found on our website, use it as a tool! Not only to answer your questions but to learn about your pain and empower yourself.
10. We respect your situation...please respect ours
We always try to treat each patient with our best service, on time, professional and respectful evaluations and treatment plans. However, as we strive to help out as many people as we can, there are times when you or other patients will need extra time during the visit. Just like we will give you extra time when needed, we may have to give other patients extra time. We simply can’t control many variables that go into our schedule, traffic, flat tires, paperwork not completed, insurance permission pending, mandatory compliance verifications and more. We respect your time and are trying to see everyone as close to the scheduled time as possible. This means you should arrive 15 minutes before your scheduled visit to complete any insurance forms or questionaries, so we can see you on time. If you are having a procedure done, we ask you to arrive 30 minutes before your scheduled time to allow for paperwork, consent, and placement of IVs. If you arrive late, we can’t make other patients who show up at their expected times wait, you may be asked to wait to see if we can work you in or even reschedule. We have late or no show fees solely to try and keep everyone arriving at their planned arrival time (not the appointment time) so we can get to your appointment on time.