Denied app to Mayo due to doctor-prescribed opioid pain medication??

Posted by Jenny @fairymystry, Dec 6, 2024

Thank you in advance for your attention.
My best friend was referred to Mayo Clinic Division of Gastroenterology in Rochester, MN by her doctor, who received a letter today from Mayo stating that they are unable to offer her an appointment. It says that, at this time, they do not feel that they would offer additional care.
This letter came today, just 3 weeks after Mayo Clinic actually called to schedule her. During the phone call, the scheduler asked her what medications she was on & she told them. One of her medications is Oxycodone - an opioid that she is prescribed for the chronic pain that she suffers. Upon hearing that, the scheduler regretfully informed her that she could not schedule her until she was off of the Oxycodone for 3 months. I completely understand the reason behind it. They need an accurate baseline of her symptoms.
That being said, that steady dose of pain medication every 4-6 hours is the only thing that keeps her out of the hospital on fentanyl for the pain. Also, the entire reason that she needs to go to Mayo Clinic so desperately is to figure out the source of the pain and stop it so that she can get off of the pain meds and go back to her regular life - she can no longer work or drive at all due to the pain and/or confusion from the pain medication, and the basic functions of daily life are difficult and time consuming for her for the same reason.
Her doctor said that she would speak to someone and see if there was anything they could do, but now 3 weeks after they were ready to schedule her, she got a denial letter. Pretty safe to assume that if the doc did talk to Mayo, it didn't help. I'm guessing that they must've determined that she wasn't willing to come off of the Oxycodone and completely denied her.
Now I'm wondering where we go from here as she's pretty upset by the news. She's convinced that she will die from this pain if she were to try to go without the medication for 3 months and she's convinced that she will die soon without help. I don't want to lose my friend.
I read on another thread that we could try applying to a different division of Mayo Clinic but they will likely still require her to be off of the opioid for 3 months and I don't guess her doc can put her on a non-opioid pain medication strong enough without damaging her liver & kidneys or she would have done that 3 weeks ago.
I'm curious if anyone has any advice.

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@fairymystry, you are a good friend to help find answers for your friend. I know you are very worried about her and want her to get the help she deserves. It sounds like there are more questions that need to be asked until you and your friend can get an understanding of what to do next.

Mayo Clinic does not require patients to be off of opioids or other pain medications before they can be seen. That said there may be situations or programs for which this is a requirement, such as the Pain Rehabilitation Center https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

As a best next step, I recommend that your friend confirm with her referring physician that they contacted Mayo Clinic. Find out what the requirements of admission are. Since your friend was intially accepted, her doctor can work with her to meet the requirements of admission. If admission depends on adjusting her current pain managment plan, her doctor can work with her and Mayo Clinic to meet the requirements and manager her pain.

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@colleenyoung

@fairymystry, you are a good friend to help find answers for your friend. I know you are very worried about her and want her to get the help she deserves. It sounds like there are more questions that need to be asked until you and your friend can get an understanding of what to do next.

Mayo Clinic does not require patients to be off of opioids or other pain medications before they can be seen. That said there may be situations or programs for which this is a requirement, such as the Pain Rehabilitation Center https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

As a best next step, I recommend that your friend confirm with her referring physician that they contacted Mayo Clinic. Find out what the requirements of admission are. Since your friend was intially accepted, her doctor can work with her to meet the requirements of admission. If admission depends on adjusting her current pain managment plan, her doctor can work with her and Mayo Clinic to meet the requirements and manager her pain.

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Thanks so much, @colleenyoung. I appreciate your reply!
Is it possible that I could find out what the specific requirements for admission are for her condition? How would I go about doing that?
I've also heard that if she is denied through one division, her doctor can re-apply to a different division - is that true?
I trust that her doctor is doing her best but there are a few outside factors bogging down the doctor's time to devote to her case, and I'd like to help to alleviate that where I can, and that seems like a fairly simple task. I should mention that I have been given special permissions by my friend to speak to her medical team and would likely be the one accompanying her to Mayo Clinic should she get admitted, so I do feel comfortable in this role if its a matter of making a phone call or even just a proper internet search. I just don't know how to physically go about it.
Any help is appreciated.

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@fairymystry

Thanks so much, @colleenyoung. I appreciate your reply!
Is it possible that I could find out what the specific requirements for admission are for her condition? How would I go about doing that?
I've also heard that if she is denied through one division, her doctor can re-apply to a different division - is that true?
I trust that her doctor is doing her best but there are a few outside factors bogging down the doctor's time to devote to her case, and I'd like to help to alleviate that where I can, and that seems like a fairly simple task. I should mention that I have been given special permissions by my friend to speak to her medical team and would likely be the one accompanying her to Mayo Clinic should she get admitted, so I do feel comfortable in this role if its a matter of making a phone call or even just a proper internet search. I just don't know how to physically go about it.
Any help is appreciated.

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@fairymystry, your best bet is to start with your friend's doctor to understand what communication they have had with Mayo Clinic thus far. Before applying to another department, make sure that all options have been explored with gastroenterology and clarify why she was first accepted, but then received a denial letter. There may have been crossed wires of communication.

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I find that unacceptable. Doctors should accept patients with long term chronic pain treatment with opioids. Try getting a referral from her PC direct to another health care provider.

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My best friend was referred to Mayo Clinic and received a phone call to schedule her. During that call, the scheduler asked what meds she was taking and, upon hearing her say that she was on Oxycodone for pain, informed her that she'd have to be off of that for 3 months before she could get an appointment. After that call, both she & her doctor received letters of denial. A couple of things:
She was pretty upset and emotional on the phone but never said that she would not comply. So why the instant denial letter after that phone call??
Also, her doctor said that she was going to speak to someone at Mayo about that but the next thing we know, the doctor got a denial letter as well and I don't guess she ever spoke to anyone at Mayo about the medication OR why she was denied.
I have posted previously about the denial having to do with the Oxycodone but was told on this forum that Mayo doesn't require that (at least not for her condition) so I don't know why the scheduler told her that.
I guess I'm needing some support knowing where to go from here & how to support my friend who is convinced that she will die soon without help. I plan to speak to her doctor with some questions (I'm authorized to communicate with her care team) but wondered if I could call Mayo Clinic myself for clarification or if it doesn't work that way.
She had an appointment with her doc today who told her to see if her GI specialist could refer her to another diagnostic hospital here in Missouri. I see that Mosaic Life Care is a Mayo Clinic Care Network member with GI specialists in St. Joseph but I don't know that she needs to be referred elsewhere - I thought her doctor was going to get answers from Mayo about the Oxycodone. To be honest, I was hoping that the doc would call, find out that the scheduler was incorrect and she would get another call to schedule.
I could use a little clarification, a direction to turn, and some advice as to how to support my friend through this.

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@fairymystry

My best friend was referred to Mayo Clinic and received a phone call to schedule her. During that call, the scheduler asked what meds she was taking and, upon hearing her say that she was on Oxycodone for pain, informed her that she'd have to be off of that for 3 months before she could get an appointment. After that call, both she & her doctor received letters of denial. A couple of things:
She was pretty upset and emotional on the phone but never said that she would not comply. So why the instant denial letter after that phone call??
Also, her doctor said that she was going to speak to someone at Mayo about that but the next thing we know, the doctor got a denial letter as well and I don't guess she ever spoke to anyone at Mayo about the medication OR why she was denied.
I have posted previously about the denial having to do with the Oxycodone but was told on this forum that Mayo doesn't require that (at least not for her condition) so I don't know why the scheduler told her that.
I guess I'm needing some support knowing where to go from here & how to support my friend who is convinced that she will die soon without help. I plan to speak to her doctor with some questions (I'm authorized to communicate with her care team) but wondered if I could call Mayo Clinic myself for clarification or if it doesn't work that way.
She had an appointment with her doc today who told her to see if her GI specialist could refer her to another diagnostic hospital here in Missouri. I see that Mosaic Life Care is a Mayo Clinic Care Network member with GI specialists in St. Joseph but I don't know that she needs to be referred elsewhere - I thought her doctor was going to get answers from Mayo about the Oxycodone. To be honest, I was hoping that the doc would call, find out that the scheduler was incorrect and she would get another call to schedule.
I could use a little clarification, a direction to turn, and some advice as to how to support my friend through this.

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@fairymystry, getting in touch with your friend's referring doctor first to find out what he learned from Mayo Clinic sounds like a good place to start. However, it sounds like he was suggesting your friend get a referral to a specialist closer to home at a large medical center.

I'm glad that you're aware of the Mayo Clinic Care Network and have done your research. Mosaic Life Care is a good option as well.

I hope the referring physician can give you more information when you speak with him.

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@fairymystry

My best friend was referred to Mayo Clinic and received a phone call to schedule her. During that call, the scheduler asked what meds she was taking and, upon hearing her say that she was on Oxycodone for pain, informed her that she'd have to be off of that for 3 months before she could get an appointment. After that call, both she & her doctor received letters of denial. A couple of things:
She was pretty upset and emotional on the phone but never said that she would not comply. So why the instant denial letter after that phone call??
Also, her doctor said that she was going to speak to someone at Mayo about that but the next thing we know, the doctor got a denial letter as well and I don't guess she ever spoke to anyone at Mayo about the medication OR why she was denied.
I have posted previously about the denial having to do with the Oxycodone but was told on this forum that Mayo doesn't require that (at least not for her condition) so I don't know why the scheduler told her that.
I guess I'm needing some support knowing where to go from here & how to support my friend who is convinced that she will die soon without help. I plan to speak to her doctor with some questions (I'm authorized to communicate with her care team) but wondered if I could call Mayo Clinic myself for clarification or if it doesn't work that way.
She had an appointment with her doc today who told her to see if her GI specialist could refer her to another diagnostic hospital here in Missouri. I see that Mosaic Life Care is a Mayo Clinic Care Network member with GI specialists in St. Joseph but I don't know that she needs to be referred elsewhere - I thought her doctor was going to get answers from Mayo about the Oxycodone. To be honest, I was hoping that the doc would call, find out that the scheduler was incorrect and she would get another call to schedule.
I could use a little clarification, a direction to turn, and some advice as to how to support my friend through this.

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Has your friend or her doctor called to speak to whomever sent the Letter of Denial? I would hope Mayo Clinic would have physicians or other credentialed staff needing to sign off on a
scheduler's decision to deny someone care. I don't know what education qualifications are
required at Mayo to be a scheduler, but it does seem this one person's decision needs to be visited again and explored...he/she may have the requirements confused or a miscommunication as Colleen said. After 13 years of followup care at Mayo Clinic for breast cancer, I just received a letter too, telling me I should receive my care closer to home, that the Breast Speciality Clinic was needed for more "complex cases". That wasn't the case when I first started there and it felt like my choice of where to receive care was taken from me, but I understand. I am getting older and the trip not as easy to do as before. That letter was signed by 2 physicians. Keep us posted of your progress. Prayers for your friend and answers to her painful condition! And for you as you advocate for her... Blessings!

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My friend is honestly feeling so defeated at this point. I recognize the pit of despair that she's in as I've been down there myself, although not for health reasons - I'm sure it has to feel 100 times worse than I've ever experienced when its your health and no one seems to want to help you.
That being said, she hasn't called Mayo herself or questioned whether her doc did. She had an appointment today but did not ask and I unfortunately wasn't there to ask myself. I think the depression over the whole thing can sometimes get in the way of her advocating for herself as it seems that sometimes she cries that no one cares and they just want her to die so she'll go away.
I'm absolutely convinced that if the doc made this phone call, she would straighten things out and they'd call to schedule again because it HAS TO be a mistake. I have a copy of the denial letters and I am an authorized representative on all of her medical paperwork so I will call myself if I have to.
I believe that the scheduler may have made a mistake as well so I have looked everywhere to find out the requirements for admission to Mayo and have found absolutely nothing about medications.
I would think that the schedulers would have to be very educated on these things too but humans make mistakes so I just want to get to the bottom of it.
I am determined to get my friend help somehow so I will call Mayo and/or her doctor myself and report what I find out.
Blessings to you as well, @luhn.

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First, Prayers for you and your friend. I recently lost a friend of mine so I understand your drive to help. May I be so bold as to ask what is going on specifically or do they not even know? I’m only asking because you mentioned denial because of pain medication but not a specific condition said pain medication as prescribed for and what immediately came to my mind was my next-door neighbor. A family member of hers has been dealing with unexplained, excruciating pain and issues with constipation, etc. for eight years I believe. Just recently she found out that she had a pretty significant amount of colon cancer. Thankfully, they just found it and immediately removed it. I didn’t know something could grow so slow and so long and it not had been caught before now. But that’s what happened so I just felt led to put it out there because if there’s anything I could’ve done to help my friend stay here longer. I would’ve as well so I felt that I at least wanted to share on the off chance that it might be helpful to you.

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Thank you, @journee! I'm so sorry for the loss of your friend and appreciate that you help others in her honor.
The specific condition is Autoimmune Pancreatitis and her symptoms are nausea, vomiting and severe abdominal pain. She's actually suffered from cyclic vomiting syndrome for many years but the pancreatitis came on a few years back & then kept reoccurring. To be fair, she's been in such poor health for so long that she's been told that she won't see 60 years old. She is 48 now. She's actually been to Mayo Clinic in the past, but not for Autoimmune Pancreatitis. The main concern that I can see is the severe abdominal pain that has her on opioid pain medication every 4 -6 hours. Its so bad that she says it feels like the GI doc that did her last UE may have nicked her pancreas because the pain has been constant since that. My research shows that that isn't really possible but that's how bad it feels. She's on steroids currently but seeing no results. Because of the pain and/or side effects of the pain medication, she can now no longer work or drive and even struggles through basic hygiene and household chores. There was talk, at one point, of doing a test for Pancreatic cancer. She had thought that the doc did one and was waiting for results only to find out that the doc didn't do the test at all. He said that he didn't see any reason to do it so the pancreas must look ok to him. Its not lost on me the magnitude of the fact that she was so eager for an answer that she was preparing herself to be diagnosed with Pancreatic cancer, which would likely be fatal. That's how badly she just wants an answer. She's looking for a new GI doc but that doesn't seem to be going well either. Her GP was supposed to help her with that but I don't think she's found anyone that can see her anytime in the next year so she's stuck with her current GI doc for now. She should find out tomorrow what he thinks of referring her to a diagnostic hospital.

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