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View Poll Results: How do you pay for your doctor visits (not prescription, that is another poll)
You Pay all (Cash, credit card) 101 68.71%
Private Insurance Co-pay -mostly you 5 3.40%
Private Insurance Co-pay -mostly insurance 19 12.93%
All insurance (or if copay <$15) 9 6.12%
Manufacturer pays (needymeds) 0 0%
Medicaid (or other government payer) 12 8.16%
Clinical study – no charge 0 0%
Other 1 0.68%
Voters: 147. You may not vote on this poll

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Unread 06-14-2011, 10:35 AM   #51
Bruceimanaddict
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Hi all, I figured I would chime in and tell my doctor\insurance experience...

I have the Aetna Plus plan for my insurance.

I was living in Jacksonville, FL when I first went to a doctor for treatment last November. I was pretty whacked out when I went to my first visit and it was all kind of a blur so I can't remember exactly what I paid for that first visit, but I want to say it was around $180. This was a doctor's office that mainly dealt with old people and their health problems, not addicts. It felt very odd going there. They didn't really know anything about how to do induction. They basically just saw me and did the regular health stuff (urine screen, blood pressure, weight, etc.) Then they gave me a prescription for 16mg of suboxen film and set me up with an appointment for a month later. The doctor did suggest I also see a psychologist. I went back to them for the next three months and it was around $80 each visit. The cost was a little bit different every time, which I always thought was odd, but I did get a receipt.

Then I moved to Charleston, SC and it was a nightmare trying to find a Suboxen doctor. I could only find 3 or 4 Suboxen doctors that were even taking patients. I had to make repeated calls to even get someone to call me back. They all wanted around $800 for a first visit. It was insane. Someone referred me to a place here call The Center for Behavioral Health. It's a private organization that has offices in a few different places around the country. They don't take insurance but I talked to someone there and they said they would wave the initial fee since I was already stable on Suboxen and had been taking it for a few months. I really had no choice because I couldn't afford $1000 to go the doctor.

Now I go to The Center for Behavioral Health and it costs me $220 a month. I'm in a voluntay, out-patient program that includes: a monthly urine test, a monthly 15 minute visit with the doctor to get my prescription, an hour long session with a pyshcologist twice a month, and a two hour group meeting with other Suboxen patients twice a month. It's all cash, out of pocket, but for everything I get I feel like it's a pretty good deal. Especially since it would cost me a $800 first time visit to switch to one of the doctors that would take my insurance, and they probably wouldn't truly care about helping me.

Thanks for letting me share.
Bruce
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Unread 06-14-2011, 02:26 PM   #52
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Hi Bruce, have you looked into submitting the receipts from your treatment to your insurance company for self-reimbursement? It might be worth a try - some insurers have the forms on their websites - if they don't, then give them a call and have them sent to you.

Just a thought - as it's worked for others.

Nancy
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Unread 06-14-2011, 02:29 PM   #53
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Hi Tom, I heard back from only one of the places I emailed - but found that I should have emailed the medical examiners board - not the insurance regulatory board. So, I'm back to square one...

Nancy
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Unread 06-14-2011, 02:50 PM   #54
Bruceimanaddict
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Quote:
Originally Posted by NancyB View Post
Hi Bruce, have you looked into submitting the receipts from your treatment to your insurance company for self-reimbursement? It might be worth a try - some insurers have the forms on their websites - if they don't, then give them a call and have them sent to you.

Just a thought - as it's worked for others.

Nancy
Hey Nancy,

I don't know why but I had never thought about that. You're right, it is worth a try. I purposely up'd my Major Medical to the "Plus" plan this year to pay for my treatment because it's supposed to give me extra coverage for things like this. With the place I'm going being a private practice type place, it's still a treatment center and should be considered "out-of-network". I should be able to get some of it reimbursed, you would think. I had just never looked at it that way.

Thank you very much for brightening my day. I'm in such ruins financially from my addiction, and even though I still have my job and make a decent paycheck, money is very tight for me. So the thought of being reimbursed any of my treatment money is music to my ears.

I will report back what I find out and whether I'm successful at getting reimbursed.

Thank you!
Bruce
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Unread 06-17-2011, 11:48 AM   #55
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Hi Bruce, I hope you can get some money back!! Let us know, fingers crossed!

Nancy
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Unread 06-17-2011, 11:53 AM   #56
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Hi Tom, slowly but surely I'm getting some answers.

This is from Maine:

Thank you for your inquiry. Most insurance companies that have a contract with a physician require that the physician accept the insurance. Failing to accept the insurance typically results in termination from the insurance carrier network. I would encourage any patient that is denied acceptance of the insurance from their physician to report it directly to the insurance company and ask if they continue to be a participating provider.

New York State:

If they participate with the carrier they may not be in compliance with their provider contract.

I'll post the responses as I get them.

Nancy
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Unread 06-17-2011, 12:36 PM   #57
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Well, I just got off the phone with the insurance people and unfortunately it wasn't very promising.

My Major Medical is Aetna Choice POS II which I get through my company in what is called the Medical Plus plan. I actually increased my MM going into this year to the Plus plan hoping that I could get some of my treatment covered. Through Aetna I am provided a company called Value Options for Mental Health/Substance Abuse.

First off, Suboxen treatment is not covered at all. That just really blows my mind. Here's a major treatment for substance abuse and they don't even cover it. However, I stated that part of my treatment are one-on-one therapy sessions and also group sessions for my addictive behavior, not nescessarilly Suboxen treatment. The lady I was talking to, who I have to say was very nice and helpful, agreed that some of those services might be covered.

The second roadblock is that I have a $2000 out-of-network deductable. I have to spend $2000 before I get reimbursed one cent.

So next time I go to the treament center, which is Monday, I am going to see about getting an itemized bill from them. If Value Options will cover some of it and I end up spending $2000 this year, they will then start reimbursing me 60%. I just don't think I will hit $2000 on the year.

I really don't know if there is more I can pursue on this. It's kind of a bummer but not really. Nothing gained nothing lost.
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Unread 06-17-2011, 03:55 PM   #58
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Thanks Nancy for the work on your end. Even though we have insurance, doctors still decide to charge cash only for the Suboxone treatment.

At least my insurance accepts it. It's hard to believe a person who has insurance wouldn't be covered for such an important treatment, like Bruce's problem. What's the use of having insurance if they don't help pay for your medical expense.

You'd think that they'd at least try to bill insurance and then the patient would be responsible for the balance.

I will make an appt. for next month with a new doctor in Nevada and see how it goes and post again here. Why this program is not being covered is ridiculous. It's been around for at least 4-5 years, yes?

Keep this sticky alive! Thanks, Tom
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Unread 08-25-2011, 01:29 PM   #59
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Post moved to new thread:

http://www.addictionsurvivors.org/vb...ad.php?t=26668
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Unread 08-25-2011, 03:01 PM   #60
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Default value options

Bruce
value options has wonderful addiction /psych coverage ....I have uhc but value options supplement. super..really.
good luck!
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Unread 08-25-2011, 03:05 PM   #61
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I meant to say CALL value options help center. they cover a ton for me...same company so it should be the same for you as well.

ahh Bruce....and all...apologies for the over post. get that itemized bill. they will pay
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Unread 10-18-2011, 12:00 AM   #62
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I didn't realize how lucky I am that my doc takes my insurance (I only pay my $30 copay, just like I do with any other doctor) and only makes me see him every 3 months. I see him and get treated with respect by both doc and staff same as any other "normal" patient is. He's a great family doc. He's now become my PCP and i'm crazy about him. He didn't bat an eye when I slipped up and ended up in hospital for a week with an infection and blood clot from iv usage during my slip. He actually did a fantastic job managing the coumadin I was having to take after got out of hosp and sent me to a hematologists like I needed. He's probably the best PCP I've ever had, and I'd never have run across him if hadn't been searching for an alternative to that greedy crook that happened to have an MD after his name.

This crook, aka doctor, wanted $500 1st visit & $250 each month, cash, no insurance accepted. He lied and told me Blue Coss wouldn't pay for Subox visits, but when I told em that 1st visit sorry don't have $500, only got my copay, they somehow found a way to get ins to pay then, just paid $150 and not the $500 he wanted. But after that he was clear, $250 no ins, cash only. Half the time I wouldn't even see doc, just give my money sit in exam room for few minutes and nurse would come in and give me my script, even though receipt clearly showed dr's exam on it, and ua too, lol. I always submitted claim to ins myself but wouldn't usually get but half the $250 back. Then, ins started mailing the reimbursement check to doc, even though I paid it all in cash and he refused my ins....what a much of crap, they said was cause new contract required them to send reimbursement checks to doc if he was a Preferred Doc, which he was. Then I was suppose to get a check from doc, lol.

Guess it's good ins did that, cause that drove me to find my current doc, who is so great. It's an extra 10 miles to drive, but well worth it. My insurance statements say they reimburse him same as what that crook charged, $250 (when u include my $30 copay). He gets ins to pay like $175 for the ua. Think he just knows the proper way to code the claim, where other doc was too stupid to. He also knows how to properly fill out ins paperwork that's required every 6 months for them to cover the Subox at the pharmacy.

Only strange thing is he doesn't put refills on script for some reason, but tells my to have pharmacy request refills from him the other 2 months I don't see him. Actually turns out better cause he'll always do it up to a week early, where no way in hell i'd get it more than 2-3 days early from rite aid if he just put 2 refill on the script. He's even called in a 3rd refill for me before when I was too busy with work to get in and let me just come the next week for appt, which I never abuse, cause want his help when I truly need it.
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Unread 10-18-2011, 12:24 AM   #63
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Forgot to mention I'm in Montgomery, AL....Doctor is less than 20 miles away from me.

There's only 5 or 6 Subox doc's in this area and mine the only one taking insurance, far as I know.
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Unread 12-01-2011, 11:55 PM   #64
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I go to the Veteran's administration. I am a vet
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Unread 03-11-2012, 11:05 PM   #65
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When I started several years ago I paid $15-20 copay and several hundred for Suboxone each month (50% copay).

A few years ago new doctor was $40 copay but $50 for scrip

He retired and referred me to psych who only took cash but charged me $40 (now $50) for a short monthly visit. Generic Subutex was $10 copay for 90 8mg tabs.

At the end of the month so does my insurance, so I can still see the psych for $50 (he will now do sessions on the phone), but a scrip would be the going cash price. Luckily I have not taken 24mgs/day for awhile and have built up a small inventory which should tide me over for awhile. I hope so because any tapering attempts have stopped me cold at 2-3mgs.

It's a shame that any doctor can get you hooked on painkillers, but you need a special DEA # (and a degree of greed) to pass out Bupe. Something wrong with that system, and subsequently the quality of many Sub doctors.
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Unread 03-20-2012, 09:39 AM   #66
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Originally Posted by a1gryphon View Post
Well, when I started last April, I lived in Knoxville, TN. I paid $80/month. I had to move to Southwest Virginia, thinking that the price wouldn't vary very much from place to place. I got here and had to start paying $175 every 2 weeks. I could go once monthly, but that would just mean that this would double, so the price remains the same.

I have begun searching for cheaper doctors. I'm sorry to report that most charge around $500 for the initial visit, and $200 weekly thereafter. These people justify this by saying that "you paid for your dope, you can pay for this". Yeah, well, most junkies committed unspeakable acts to get their dope money, and, once clean, they can no longer perform these acts in good conscience. I mean, the point IS to learn to live like we did before we became addicted, NOT to have to continue the same behaviors, and then show up at our local NA meeting and talk about what a great day we had because we had to go suck somebody's d*** for $100 to help pay for our suboxone visit!!!

Anyway, as I said, I am hellbent on finding someone cheaper, OR some other way to get this need of mine met. I found that Medicaid (only in some states) will reimburse YOU if you pay the doctor up front and fill out the necessary paperwork. I attempted to call my state's Medicaid office to determine if this applies here, only to be greeted by some uneducated nitwit who couldn't even understand the question being put to them. I explained that I am paying $175 every two weeks for my suboxone visits, and this idiot interrupted me saying, "Why are you paying your provider yourself?"

I answered that few, if any doctors accept insurance for suboxone visits. I inquired as to whether or not they would reimburse patients for these visits, she scoffed and said, "Huh, we're NOT going to send you any money. If your doctor doesn't accept Medicaid, then we don't pay for it."

I had to explain that Medicaid DOES do this in some states, and I suspect that they do it here, as I'd seen it alluded to on the internet somewhere. Shoot, last year I worked for Medicaid myself and I know first hand that they reimburse for all kinds of things, I'm just not sure about suboxone visits.

This person clearly didn't understand what I was asking at all. And this is apparently the only avenue of reaching a live person at Medicaid.

If I can't find a person who knows how to do their job, then HOW am I supposed to get anywhere?

I am so very vexed at this point and just feel like shooting myself.

Anyway, I believe that if we all just took a stand together somehow, wrote our representatives or SOMETHING to that effect, then we could make all this bullshit disappear. That's what it is. Bullshit. I don't see doctors charging all that cash up front for cancer patients. Suboxone is the most effective thing out there for opiate addicts, and it is very, very rapidly becoming impossible to pay for.

Absolutely ridiculous. Maddening. Come on. Let's get something done about this.
I live near Knoxville TN and I am looking for a doctor I can afford. I have "TennCare" but I can't find a doc who will take it. They all say they only take cash. And they want 450.00 for the first visit plus I would have to go in 3 times a week to take drug test which are 50 bucks each. Then the 2nd month it's 250.00 office visit plus 3 times a week drug test 50.00 each. Then one I get to the 3rd month it's 250.00 month but with only 1 drug test. How in the world am I suppose to afford that? So I was wondering if you could send me the docs name or number that you seen in Knoxville that was only 80 bucks a month. If not I understand just trying to get help from anyone I can. Thank you Rmajor
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Unread 10-18-2012, 02:35 PM   #67
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Need a doc that takes insurance that I have from work
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Unread 10-18-2012, 02:41 PM   #68
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It doesn't matter if you have Medicade or I private insurance that you pay for through employment. It's just crazy all the docs that kept feeding me all those pain pills for 12 years didn't ave a problem taking insurance. Find a doc that can actually help us addicts out and they want cash! It make no kind of since to me.
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Unread 10-18-2012, 02:46 PM   #69
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You didn't say where you're from or how far you can travel. There is a physician matching system on the site somewhere, nancy will likely post a link..

I have a doctor in upstate NY who doesn't take insurance, but is cheaper than most copays.

If you have prescription insurance, where you are really doesn't matter much.
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Unread 10-18-2012, 07:39 PM   #70
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Hi Amy, this link has different ways to find a doctor:
http://www.addictionsurvivors.org/vb...ad.php?t=21259

Have you contacted your insurance company to see if they can help you find a provider that's in your network? Also check to see if there's a list on the insurer's website that you can use.

Nancy
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Unread 01-14-2013, 04:20 PM   #71
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Cool Insurance not helping

Post moved to new thread:
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Unread 12-03-2013, 07:19 PM   #72
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Hey everyone I just wanted to share my story. Ive been on Bup for almost a year and have had 2 doctors and will see the 3rd later this week. Thank goodness! lol
The first doctor I seen here in Indianapolis was cash only. I have IN Medicaid but I knew very little about suboxone or suboxone doctors and knew I might have to pay cash, so I did. I payed $300 for the initial visit. I returned monthly and paid $120. I was shocked (when I returned to what I thought was a doctors appointment) to see about 50 people lined up out side the doctors office. The doctor had told me to be there between 7am and 10pm on a Saturday morning, which I thought was odd. So I found out later that every patient came in the 3rd Saturday between those hours to "pick up" their scipt. We didnt see the doctor, we didnt get a drug screen, we simply handed a lady our money and she handed us a script. I only returned there a few months. I then found my 2nd doctor. A friend gave me his # and I got right in. This doctor didnt take my Medicaid either but was cheaper. I paid $190 the first visit and returned every 2 weeks and paid $45. This new doctor was caring, professional, and very unlike the previous doc. Every 6 months he done a PA so Medicaid would pay for the script to be filled.I also got drug tested every 2 weeks when I saw him and it was not extra. I really liked him. He recently moved out of state and left me to find a new doctor, which proved to be very challenging. I called every doctor in the suboxone directory in my area. The doctors werent taking Medicaid patients or was cash only and when they found out I had Medicaid said they couldnt accept me. I tried to explain to them that I could be self pay and have medicaid if they were willing to do a PA but they told me it wouldnt be approved. What? My previous doctor got me approved for 9 months, 3 different PA's. Alot of these MA's or secretaries dont know what theyre talking about. I am currently running out of medicine and getting very nervous. I went to fill out a patient packet yesterday at a doctors office where I thought I could be a cash patient. I told the girl on the phone that I had medicaid but was willing to pay cash and she said no problem. So I drive 30 minutes to fill out the packet. I fill it out drive home and get a phone call. The young receptionist tells me that they ran my social and see that I have Medicaid and they cant see me cause the doc is not a medicaid doc. Geez I cant catch a break. I was really counting on seeing that doc this week before I ran out of medication. I was crushed. But I couldnt give up. So I looked up some numbers of psychiatrist late last night and came across a facility that I knew I hadnt called yet. Their ad didnt mention suboxone but I jotted down the number anyway. So I called this morning and they do have a bup doctor and they take my medicaid. My stomach was in knots the whole time I was on the phone with this nice lady (I was expecting for her to say she made a mistake or something). So my story ends here, I see this new doctor Friday morning and it will cost me nothing. I cant believe it. Thanks for letting me share.
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Unread 12-17-2013, 03:03 PM   #73
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I've been paying out of pocket. About $800 a month. But starting next month, Obamacare will save my life. All those with insurance complaining that theirs is going up some, I'm sorry. Better that than most people being denied access.
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Unread 12-18-2013, 02:45 AM   #74
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Next month, it will save my butt too. He lost his job but after unemployment/food stamps, Medicaid, Lifeline and LIHEAP we should be ok. I just hate the hoop jumping and running around to get it all going. I need a working printer and I will be good to go. A working printer would save me alot of trouble and gas LOL. We got approved for Medicaid because of his income being alot lower. I hate it because the income is lower but the medicine cost will be so much cheaper than ever. I have never paid any less than 7.50 a piece for them. I got a year of the free meds, it just never seems like it lasts long enough.
The Medicaid doesn't pay for the visit because my doctor doesn't accept it. I just wish that I could get my PCP doctor to give me my Sub because he accepts it. I might have to find another doctor, I hate to but if I have to I will do it.
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Unread 12-18-2013, 07:58 AM   #75
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Hi April, we've had people write to us about different issues with Medicaid in various states; I wanted to check into it a little because a couple of things you mentioned were similar - and to possibly avoid surprises for you when you went to the doctor.

It looks like you need a doctor who is in the Medicaid system or else your prescription won't be covered. This is from 2011, but I didn't find any updates saying differently.

http://www.chfs.ky.gov/NR/rdonlyres/...orJune2011.pdf

Effective July 5, 2011, DMS will no longer add non-Medicaid prescribers to our files and there will be no reimbursement for prescriptions by non-Medicaid providers, which will result in prescriptions denying. Please notify your patients that if they accept a prescription from a non-Medicaid provider, DMS will not pay for the prescription.

I also found this - if you have CoventryCares Medicaid - it's a little weird because it says: KENTUCKY MEDICAID BUPRENORPHINE/NALOXONE (Suboxone) PRIOR AUTHORIZATION FORM

But then it says: The following Coverage Policy applies to all non-Medicare health benefit plans.

Which seems contradictory. In any event, it looks like off-label prescribing of buprenorphine wouldn't be covered, so your PCP wouldn't be able to prescribe it and have it covered unless he gets his "X" number. It also looks like you must engage in therapy.

http://chcmedicaid-kentucky.coventry...nt/c065036.pdf

Coverage Policy: Covered for the treatment of opioid dependence when ALL of the following conditions are met:

Diagnosis of opioid dependence, AND Verification from the prescriber that he/she meets all of the qualification criteria to prescribe Suboxone, and has this unique registration with the DEA, AND Participation in formal substance abuse counseling or treatment program; OR if the prescriber is a psychiatrist or certified addiction specialist, verification that he/she personally renders counseling services, AND The date and request number from the Kasper Report and a list of all controlled substances obtained by the patient within the last 30 days from the report, AND Documentation of the proposed length of treatment including a dose taper plan.

NOTE: Buprenorphine/naloxone is the covered product when criteria are met. Requests for sublingual film will be reviewed for medical necessity.
Authorization renewals: Available upon pharmacist review. The pharmacist will verify continued participation in a psychosocial support program, and review the patient’s profile to ensure compliance and check for concurrent narcotics. Documentation of opiate-free urine drug screen will be required upon renewal.

Reasons for Non-Coverage:
● Requests for the diagnosis of acute or chronic pain
● Non-adherence to therapy and/or provider/patient contract Concurrent use of opioids while using buprenorphine/naloxone
● Lack of participation in a counseling/treatment program


So please think about really looking into it to make sure the insurance carrier you end up with doesn't have any surprises for you.

Hope that's helpful.

Nancy
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Unread 12-19-2013, 02:35 AM   #76
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No we have Wellcare. I called my doctor's office and made sure that they could tell me which insurance it paid for and its also in their formulary. We had to make sure that there was one that accepted my medication so I figured I would go through all their drug formularies. Coventry Cares doesn't even have it in their formulary and my doctor reassured me that Wellcare and there was another one that accepts it too.
I read over their policy and formulary, everything sounds ok to me. There is four Medicaid providers in our state. I liked the perks that Coventry Care had, but they didn't pay for anything Suboxone wise. They didn't even have the generic or Subutex in their formulary.
There were two in the list that had it in there. I also spoke to a lady in the office over there a couple months back and she said that she had Medicaid and it paid for every dime but she had Wellcare as well.
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Unread 01-13-2014, 09:28 PM   #77
Mongoose
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Default In the begining

Quote:
Originally Posted by ADMIN View Post
How do you pay for your doctor visit? Please answer in the poll above, thank you!
When i started this medicine I was in bad shape addicted to loratabs and other opioids.
When i started this medicine I was single and didnt have a care. When i started this medicine my dr was accepting blue cross blue shield.
(my copay was $25 a month)
When i started this medicine I was perscribed 2 subs a day.
This medicine is a life saver.I think it literally saved my life.
But now a days i'm perscribed 1 and a half a day.
Now a days my dr does not accept blue cross blue sheild.
(thanks Oboma!)
Now a days i'm married with 2 beautiful kids,have a brand new house and a brand new vehicle(well my wife does!)
Anyway what i'm trying to say is I know i can get this medicine cheaper
from a street pharmacist but I'm trying to do what is right(and legal).
So I guess from now on I will continue to struggle with trying to keep everyone happy, keeping my bills paid on time, and controlling my own demons. I just wish there was an easier and cheaper way to get the medicine I need.
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Unread 07-06-2016, 11:01 AM   #78
lahopeful
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honestly, i don't think most of you have ANYTHING to complain about. I have pretty good insurance through work but my doctor doesn't even take insurance. I pay $300 to $330 a month.
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Unread 07-13-2016, 09:51 AM   #79
MattC42286
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Hi bruceiman addict! Wow is all i can say. Hope things pick up for you and this insurance is better than your last. They usually pay most of the costs for the program. Good luck and God bless!!!! Tha ks, Matt
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Unread 07-13-2016, 10:15 AM   #80
MattC42286
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Hi bruciemanaddict! I would try and see if you can turn your receipts in to your insurance. They may reimburse you for any out of pocket costs. Definately worth a try all they can do is say no..! Good luck and God bless!! Thabks, Matt
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