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How does one know if they've been "red flagged"?
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How does one know if they've been "red flagged"?

I've read many posts concerning this topic today. My own situation began about a 1 1/2 years ago following a car accident. I sustained acute whiplash and a torn shoulder labrum. I've had two surgeries for my shoulder but there is still pain. My neck has never stopped hurting. Last month my primary ordered a CT and discovered that my lower back is in a bad state as well. I have been getting hydrocodone 7.5/500 for my shoulder from the ortho that repaired it. My primary has prescribed hydrocodone 10/500 for my back. These scripts have crossed over three times. My tolerance levels have built up so high that the prescribed doses are no longer effective. When I called Walmart yesterday to ask for my 10's refill, the attendant told me that my refill was not due until Oct. 20th. I questioned her as to why and she couldn't figure out the insurance rejection either so she placed my call on hold and asked the pharmacist. When she came back on the line she told me that it appeared I was getting the meds at another pharmacy too, and now she had to call the insurance company to get the name of the other pharmacy(I can only assume as to why she needed that info). I told her that the pharmacy was Rite Aid but the meds were two totally different strengths. She said it didn't matter because it was the same med regardless of strength. My heart hit the floor. I told her I was terribly sorry and that I did not realize this was an issue. I had used Rite Aid following both of my shoulder surgeries, but had gotten fed up with them missing voicemails from my doctor for refill info. I told her when I changed to my new primary I also changed pharmacies. After my explanation she said ok and told me that my next refill date is for October 20th. Does this sound like an issue to anyone? Is she required to report this in the state of Georgia? She didn't imply that the matter would go any further but after reading about 300 or so posts concerning the phenomena known as "Dr.Shopping" between yesterday and today I am thoroughly terrified. I'm afraid to go back in to see my ortho for my final visit now for fear he has been contacted by the insurance co., pharmacy, or DEA. That would be humiliating! How do I know if I've been flagged and why did the insurance company allow the previous three cross over scripts is this is wrong?
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271792_tn?1334983257
Please don't start new posts. Also, please understand that most members work or have commitments. Please be patient.

What you are doing IS doctor shopping. Most likely you will be flagged and both of your doctors will be notified. You may be banned from filling scripts for narcotics. It depends on the pharmacy, your doctor and rules & regulations in your state.

I guess the bottom line is do you think you have a problem and would you like help getting and staying off of the drugs?
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1412212_tn?1285603028
Yes this looks like Dr. Shopping. I know this all to well because I did this myself and got caught. This is a violation and you could get into serious trouble. This is what happens... The insurance company will send a copy to all the Dr.'s and pharmacies involved. This should open your eyes to see that there is a bigger issue at hand. I can no longer get scripts for these narcotics from the dr.'s... and the pharmacies have me flagged. You really need to think about is your life worth the stress of wondering where to get the next pill? I know what you are going through- I was hit by an 18 wheeler and have had surgeries myself but I also needed to gain my life back. I almost 50 days clean and feel alive again.
You need to be proactive and call your dr before they drop you.
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Avatar_f_tn
How can going to my primary and the surgeon she referred me to be dr.shopping? Tone cannot be relayed in emails so please know I'm sincere when I ask that question. The two doctors are aware of one another and my insurance was always billed. If I thought I was doing something wrong this would not make any sense.
The insurance did not kick back the first two scripts. Why not? This would alleviate any misunderstandings for patients and their physicians. Do they intentionally build cases then grab the unsuspecting person?

I realize when this is over and my back is fixed, as well as any other further treatment for my neck and shoulder, I will be firmly addicted to this medication. I suppose one could even say now that I am dependent/addicted. I have to do something for pain relief until the problem is corrected though. I'm taking medication as well as injections, heat, ice, inversion table therapy. Reading some of the other posts frighten me as to what lies in store with withdrawals and such but how do you withdraw when you still need the meds to get in a standing position each day? Not high like many post, just physically tolerate moving?
I meet with the neurosurgeon next month, October, for a correction on my lower spine. He has wonderful reviews and hopefully this will remedy my situation.
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271792_tn?1334983257
Doctor shopping is when you have more than one script for narcotics, regardless of the strength and reason for taking it. It is illegal. I don't know why the insurance company let it go through. Some are just getting caught up and realizing what is going on. The crack down from the DEA started about 3 and 1/2 half years ago. Some are slower than others I assume.

Curious, have you tried to go for any time without the pain meds? I ask because it may be possible you re experiencing re-bound pain. I have had major back reconstruction surgery and, years later, an accident. I relapsed on pain meds and went years not realizing they were not helping and the pain was not, and is not, as bad as my body and brain were telling me it was. I did the shots, the physical therapy, the aqua therapy and acupuncture. I now have home remedies that usually can get me through a bad spell if it goes out (my back).

You may or may not lose your prescriptions. Either way, some day soon you will have to find alternative pain remedies and come off of those evil pills. We can help you through this and support you. There is a great group of members here.
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1218318_tn?1266812201
I can really identify with you on your meds losing their effectiveness. I went through that also. The first time I took a vicodin 7.5 in my life was for 9+ out of 10 pain from a back injury. It didn't even touch the pain, but it helped me to "ignore" the pain somewhat for a short duration. FF to a year later, I had become addicted, which is to be expected, according to the instruction sheet that came with my prescription. I found I was needing more and more to fill the same need, which was more for brain than pain. I got my Doctor to up my monthly count, but he said "Wow, that's a lot of Vicodin!" Soon I found myself looking at "Roxies" on RxList and trying to figure out how to get them. But instead I decided to do everything I could to work through my pain and end my affair with opiates before it's too late. After all, at the end of that path lurked some really powerful street drugs. I know that no two backs are exactly the same, but I was able to walk an average of 3 miles a day, do PT, use Naproxin and so-forth to make pain tolerable, but that's me.

Being addicted to opiates is no real secret in our society, but I know first-hand it's an ugly stigma to overcome. It's really nothing for you to ever be ashamed of, provided you accept your dilemma honestly, and take positive action. Speaking of positive, what if you looked for a hidden blessing in what is going on in your life right now? Someone or something is looking out for you! You're at a fork in the road.

Our header on the top of the page reads: "This Substance Abuse Community is a place to share information and support with others who are trying to stop using drugs, prescription drugs, alcohol, tobacco or other addictive substances." There's a reason you posted here. I wish you the best and I hope your back pain gets better.
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Avatar_f_tn
Oh definitely. I've been off and on the meds several times now. The withdrawals are not so bad after 5-6 weeks of use but this time I've been using them fairly steady for about 4 months. I did try to come down to Motrin but I'm a gastric patient and it burned an ulcer into my pouch. Tylenol is safe but it was useless on the pain. I wound back up in the ER getting a shot for break away pain and went back to see the surgeon. He placed me back on the hydrocodone.
I mentioned the other sources for pain relief that I use above.
I went to my PCP last month because I began experiencing some horrible lower back pain. I crawled out of bed one morning thinking I'd been hit by a truck. She ran a ct scan, then a myleogram and found significant damaged to L3,4, & 5. S-1 is also under pressure. It's so strange; I have never experienced any back pain in my life so how this hid for so long is amazing. My doctor called with the results and told me she had called in three meds to the pharmacy I listed. I picked them up and one was the new script for a higher strength hydro. All of this could be avoided if the insurance refused the payment and the pharmacist explained that it was wrong. I understand from all my reading that some people do this intentionally and with 5-6 doctors but that is not my case at all. Two separate strength meds in my mind, two doctors who were totally aware of one another did not constitute anything illegal. Apparently it is though. The attendant at the pharmacy seemed calm and understanding when I told her I did not realize that two separate strength medicines was a no-no. She explained the acetaminophen issues and I told her that made sense because my abdomen seemed to hurt a lot as of late. After I apologized for the misunderstanding she said "Ok, your next refill WITH US will be ready on October 20." I thanked her and we hung up. If she were going to throw me to the dogs it seems as if she would have done what many of these other posters have discussed. Wouldn't she have told me that she was going to call my doctor and that the scripts would be voided or something?
The script is not my concern at the moment, the legal issue is.
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Avatar_f_tn
Okay. I'm reasonably sure this is going to be okay. It DOES raise a red flag with the DEA. This stuff automatically gets spit out to a larger network of computers.  But,it's only been three times and two doctors.  It's not showing a huge pattern yet.  It's good both doctors know about the other. Do they know the other is prescribing hydro? That's what the DEA and pharmacy want to be sure of. The insurance company comes into play also. They won't OK a 2nd RX if it's within the timeline of the other. They keep track,also,but for their own reasons.   There are several checks and balances in place,for good reason. Most are to protect you (and me! ).

I suggest you do this: Let BOTH doctors know what has happened. You need to do this.
Just be up front. You won't be seeing the ortho much longer and it's good for you to
bring it up. You want that record "tidy". You may need him again.

Speak with your PCP and tell her.  It's apparent you're not getting enough pain relief and that's easy to fix without taking all that Tylenol. She may suggest some PT,also.

The thing is,they will hear about this and it's important that you let them know it's come to YOUR attention. It's not a bad thing you did. You,apparently didn't know this was such a problem in our world.

It would probably be best if you keep all the narcotic use with one doctor from now on. I
guess that goes without saying.

As an aside,I think that doctor's should inform their patients about this. This happens a lot with people who are on one pain med with their doctor and then have a root canal treatment and get the same med for THAT pain.  In honesty,most people don't get the 2nd RX because they already have the med. And some of us just go ahead...

Try not to worry...just clear it up. It's an easy fix.
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Avatar_f_tn
Thank you! It is going to be awkward to say the least to have to inform the doctors about the overlapping scripts but I really have no choice at this point. No, to answer your question as to whether the doctors knew specifically about my meds. My pcp referred me to my ortho for repair so to me it was a no brainer. She knew I was seeing him and it never crossed my mind.

The doctors could REALLY help people like me who live "sheltered lives" as far as these things go. Adjusting to a higher dosage due to tolerance levels would be my admitted only crime. In retrospect I should have asked the pharmacist when I saw that the new hydro was in my bag of meds that first time. I was so tickled to have the extra because my other dosage was not helping at all.

I'd rather change doctors and take the cowards way out but that would only raise more flags. No need to do that! lol!!

I think the humiliation of having to talk to both doctors is actually worse than knowing I committed a crime. Regardless what I say I'm sure I'll be judged.

It seems so harsh to me that counseling is not offered for a first offense like this; maybe a one strike type thing.  Doctors don't tell us, the pharmacists on tell us AFTER the fact, the insurance company pays for scripts so the DEA can have a case against us??? This is messed up.
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Avatar_f_tn

"As an aside,I think that doctor's should inform their patients about this. This happens a lot with people who are on one pain med with their doctor and then have a root canal treatment and get the same med for THAT pain.  In honesty,most people don't get the 2nd RX because they already have the med. And some of us just go ahead... "

And some doctors will give you more anyway.  I broke my little toe about 6 years ago and I gave the ER all the info on my meds I was currently taking (Fentanyl 25mcg and VicodinES).  The ER doc asked me if I had any vicodin left at home, and I said, "Yeah, I have some"  And he wrote me a script for 15 more!  (Which I took, of course, I was just an honest addict..lol)
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Avatar_f_tn
Tooold  ~~ LMAO    "honest addict" is an oxymoron !!!  Can't fool me!!

The ER is the exception to the rule here.  He gave you just enough to cover the pain you came IN with. 15 pills is nothing to an addict and it's self serving to the doctor because he's covered and you probably won't come back during HIS shift !!

"Yeah...I have SOME"...   LOL
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Avatar_f_tn
You guys are hilarious. :) Thanks for the smile because I needed it today. Funny, you think I would be upset about not having any meds. Instead all I've thought about since yesterday is seeing black and white cop cars pull into my driveway.
I think that fear has been put to bed now. I just need to muster the courage to tell my docs about the double trouble scripts.
There is so much misinformation out on the web. Many posts say that you are only red flagged for class II drugs (hydro is III). Others say you can be flagged for Tramadol and I looked it up; it's not even a narcotic! Round and round we go!
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271792_tn?1334983257
At some point, you will need to get humble...
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Avatar_f_tn
Double....

Tramadol IS a synthetic opiate. Trust me. It also has an antidepressant quality. Don't ever take it!!  It's a bear!

Okay..I think you're okay here. It's not a big deal to call or tell the doctors when you see them. They'll probably just say" Oh...Okay".  After all,they are complicit in this,too. Everyone has a responsibility here. To me, I see what happened. You got one RX from the ortho then you got some called in by the PCP and included in that was some hydro. I get that. It had refills. I get that. NO ONE said anything to you!!!   THEN you get shut down at the pharmacy.  It's crappy and confusing.

I doubt anything will happen. Just let one or the other know. I'm thinking your PCP. Just tell her. This does happen. You need to talk to her anyway about the strength etc..

I'll just share something that I thought was really cool.  I saw an orthopedist a while back
when I broke my leg in 3 places. (Don't ask )   Of course it hurt and I needed pain med.
Fine. This is the cool thing:  His policy was to have everyone sign a "contract" stating they would not get any narcotics from any other doctor as long as they were under his care.  Being a professional addict,I knew not to do this but the average guy on the
street wouldn't know!!   Well,his patients did!  It was a great service to just inform his patients about what was okay and what wasn't.

Anyway,just relax about this. The cops aren't coming. If they do,just do what I do: Don't open the door!!

I'm kidding!!   Post back if you're still nervous~or anytime!
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Avatar_f_tn
Vicki, yer killin' me today!  Don't answer the door...LOL

I considered adding an addendum to my post about the honest addict, but i figured someone would see the irony in it! LOL
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Avatar_f_tn
Tooold~~

I saw the irony,of course!!   I happen to be in a good mood. Funny how that happens...
you "get clean" and the humor in your world returns!

Glad I made you laugh!!  It's important...
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Avatar_f_tn
IBKleen- Humility is a wonderful attribute that few possess. Humiliation is a different issue. Saying "I did something wrong and I'm sorry" is not the issue. It's the horrible judgment that many many people suffer unjustly on a daily basis by professionals in the medical community.
With NO record of any previous medical issues my pcp blew off my injuries for 5 months after the initial car accident. No meds, nothing. I sought out an ortho on my own who immediately diagnosed the injury and within two weeks I was in surgery. At least the pcp was kind enough to give me the referral when I gave up on her help.
After my results came back I took the paper back into to her office; do you think she was remorseful for her horrible care? No. She never once apologized. I re-tore the repair job just days after the initial repair and again this woman blew me off. I changed pcp's and the rest is history. My new physician listened and sent me back for another repair. When the ortho that fixed my tear felt his work was "unbreakable," the new pcp sent me to another ortho who listened. The new surgeon open up my shoulder and found an absolute mess.

When we truly listen to one another progress is made.

For someone who does not need the medication for pain control, I understand the advice of going without. But for justified issues, medical results from tests confirming bonified injuries that are excruciatingly painful, I do not.
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Avatar_f_tn
You've really been through it!  Okay...are you out of pain meds now?  I think you are.

You might want to call and try to get in to see your new PCP tomorrow. You'll have a rough weekend if you don't get some meds.  She can prescribe something other than hydro for your pain. It will get filled because it's different.

Let us know~~  Also,MedHelp has a pain management forum. You might want to read some posts over there,also. This kind of thing comes up quite a bit with chronic pain management.

Keep in touch...I'd like to know how this resolved for you.
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Avatar_f_tn
I am out and thank you Vicki. My pcp is out until Monday. I tried yesterday to call her to explain the issue and the staff said she was out. I did speak to her nurse about it though; she told me that the two previous times I had called in my doctor was either off or on vacation so she had turned in my request to the doctors inside the clinic that my doctor partners with....there are about ten doctors at this one particular establishment. When we call in for our refills we simply leave a voice mail, and if the doctor approves the refill, it is called in to our pharmacy...IN THAT DOCTOR'S NAME!
There was no way I could have known another doctor at her office was approving any of my scripts without looking at the tiny type on the bottle..who does that? She said it's totally fine in those situations because it's STILL a physician inside the same group and they have full access to my file. The nurse said where I was looking at the issue of it being my pcp and ortho, my insurance was seeing those two doctors PLUS two more names because the refills were under Dr. Corn, and Dr. Bedford. She said the ortho's script was the only one I needed to be concerned with and that she would explain to my pcp Monday. I think everything will be ok now. I understand more clearly as to why a flag went up when the insurance company saw four different names.
Honestly I would like to attempt to see how long I can go without meds since this situation has presented itself to me.
If the pain becomes intolerable I can always go to the ER and ask for an injection. I haven't been since the night following my accident and before that I had never been there...it's a miserable place but we do what we need to I suppose. :) There is a nurse at my gym who works at our local hospital and she gave me the idea this morning. By Monday if I need something I can call in to my doctor for an appt.
Thank you so much for the encouragement. If the ortho is less understanding and I'm flagged then I'll just cross that bridge when it comes up. Hopefully nothing will come of it...in the meantime I have learned a tremendous piece of information.
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Avatar_f_tn
Were you arrested? I have just been caught doc shopping between two docs. I have been reported to DEA and red-flagged but have no idea if agents will show up at my door to arrest me. I was getting Ultram, a controlled substance, yes, but not a schedule II like Oxy or something like that. It was seriously the FIRST time I overlapped and i was caught. I have NO record of any kind, but I am terrified. I am praying that some time will pass and they will just monitor my record to make sure that I don't continue. Is this what happened to you or did you get into legal trouble?
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2083449_tn?1381358308
Hi nan! This is an old post and it is unlikely that the original poster is around to answer your question! You might want to start a new thread, and tell your story about what happened. Then you can get some answers, support and help! Just go to the top of the page and click on the "Post a Question" button! Good luck! There are lots of wonderful people here that can give you information and support!
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1140115_tn?1348499315
This discussion's several years old and the original poster isn't likely to be looking for any more opinions, so we'll close this thread now.  If you have a question or a discussion you'd like to start, you can do so by clicking the "Post a Question" button at the top of the forum page.  Thanks!

Claire
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