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Unread 05-03-2011, 04:10 PM   #1
Selena15
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Posts: 161
Default Ins.Co./Dr..Any Advice?

I believe I wrote a lil bit about this a few days ago and not sure whee to find it.
Anyway,I've been having a terrible time with my Ins. to pay for Suboxone. I was denied and I'm now Appealing it. Dr. office keeps sending the wrong info even after I took them exactly what they needed.
I call the Dr. office this morning to ask about it. She tells me the Dr. can not do this and I'll just need to find a way to pay for it.
So,I call the Ins. back and ask what can I do? She asked me the Dr. phone number and put me on hold. She come back and said the answering service came on. It's almost impossible to get them to answer or call back.
Ins. Co. told me the Dr. does not have to get involved they office can. So,I got dressed and went to the Dr. office. I told her what they told me. She wrote all this down and then tells me the Dr. DOES have to be involved. i've had seizures in the past and take meds for it. She said they couldn't tell them that. I said send my records to them.
So,she said she would see what she could do.

I think something is very shady here. The Dr.office obviously does not want to have to do what is needed. I do see the Dr. next week and if this doesn't get resolved by then it will be interesting to see what he has to say about this.
Also,nurse said he does not write scripts for Subutex. I'll ask about that as well.
It's bad enough to have to deal with the Ins.but,to have to deal with the office and they will not do there job is just unacceptable.

I've been dealing with this for 2 weeks everyday. I'm totally stressed out and don't know what I'll do if I cannot get this approved. I've been buying the Suboxone but I'm putting us in a terrible financial situation. I can't continue to do this.

It's amazing how the Ins. will pay for many opiates but not for something to help you to get off.
I'm trying to stay cool as to not piss someone off but it's getting hard.

Any advice would be greatly appreciated

Selena
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Unread 05-04-2011, 09:32 AM   #2
Jack123
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Posts: 107
Question Shady

Hi Selena,

Shady? That was an interesting choice of words. I too used that word to describe what I saw going on with Sub, and particularly the docs who give it out. And I mean from 7 years ago. There was a board about Sub back then, but I don't think it was as good as this board is. But even though we both used the same word, I'm not sure we both mean the same things. Nevertheless, the things I used to read about the Sub docs back then were unbelievable. Some of the Sub docs used to sell the pills to the patients, and sometimes at very exorbitant prices. The people complained on the board, but they couldn't complain any where else. No one cared. It seemed as if the Sub docs had carte blanch, and could do whatever they pleased. Almost none of them accepted insurance, and their prices varied from $100 to over $500 for the 1st visit. My 2nd Sub do was moderately priced, but he had the temperament of a raging Lion. He spoke down to me, and treated me like I was a criminal. He spoke to me as though I had been a Heroin addict who was busted and I was now there by a court order. He wanted me to feel privileged that he was wasting his time on trash like me. But the reality of the situation was that I had become opiate dependent due to taking pain pills for real pain. I wasn't using Heroin at all. And my pain syndrome was well documented using a MRI machine, as well as the clinical expertise of several top notch neurologists and PM docs. And I hadn't been arrested at all. I was there voluntarily, and he was verbally abusing me and charging me a good deal of cash to be his whipping post. But I was so scared back then, of pain and wds, that I was putting up with him. Five months later he found a reason to throw me out, which he had predicted he would do, and it turned out to be a blessing in disguise. After him I found a wonderful Sub doc. One reason was because I had discovered a Sub doc finding web site. I also had enough Sub pills to hold me over, until I spoke to a doc on the phone who sounded decent.

So Selena things seem better to me than they were. But your doc sounds like he still operates the way they did 7 years ago. As far as I know, they were never obligated to take insurance, if fact they weren't supposed to take it. Unless that's changed, and I don't know, then the last thing they're going to do is to fight with your insurance co. They also weren't obligated to give out Subutex, and again, they weren't even supposed to. The rationale for this is that Sub was meant to be used with Heroin addicts. It was an alternative to Methadone. Since most Heroin addicts used to inject their drug, Subutex was never to be given to them other than to induct them onto Sub. Since many, or most, Sub users today are pain victims, Subutex should be given out with no worries that we're going to inject it. But it's not. Society, as well as the medical profession hangs onto the idea that all opiate addicts are criminals and liars. Indeed, the word addict is synonymous with being a liar. So when we tell them we never used Heroin, we aren't necessarily believed. This is one reason I want our disease given a new name. A name that is medical terminology. It's also why I have been struggling now for close to 20 years to come up with a theory of what this disease actually is. I know I can't really accomplish that, but I may be able to come up with ideas that real doctors can build on.

These are all my ideas and my opinions, and not to be taken as facts. I also hope most of this has changed in the last 7 years.

I think it's terrible Selena, the way you're being treated. All I can suggest is changing docs. I think I too am going to be faced with this in a month or so. I hope someone else has some real advice for you, something that can help. I just wanted to share what you made me think of when you said Shady. There is definitely something shady going on. The question is what?

Jack
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Unread 05-04-2011, 10:16 AM   #3
NancyB
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Quote:
Originally Posted by Jack123 View Post
As far as I know, they were never obligated to take insurance, if fact they weren't supposed to take it. Unless that's changed, and I don't know, then the last thing they're going to do is to fight with your insurance co. They also weren't obligated to give out Subutex, and again, they weren't even supposed to.
Hi Jack, doctors are supposed to take a patient's insurance if they are the patient's insurance network. They can actually get in trouble if they don't. But unfortunately, there are the doctors who just refuse. The patient can always submit their receipts to the insurance company on their own for direct reimbursement as an alternative.

Doctors could always prescribe Subutex to patients - especially pregnant women, because eliminating the naloxone was eliminating another med the woman took. Many doctors are still fearful of prescribing -tex because -one is the recommended formulation because of diversion.

Hope that helps in clearing that up.

Nancy
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Unread 05-04-2011, 10:27 AM   #4
NancyB
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Quote:
Originally Posted by Selena15 View Post
So,I call the Ins. back and ask what can I do? She asked me the Dr. phone number and put me on hold. She come back and said the answering service came on. It's almost impossible to get them to answer or call back.
Ins. Co. told me the Dr. does not have to get involved they office can. So,I got dressed and went to the Dr. office. I told her what they told me. She wrote all this down and then tells me the Dr. DOES have to be involved. i've had seizures in the past and take meds for it. She said they couldn't tell them that. I said send my records to them.
So,she said she would see what she could do.
Hi Selena, did you get the name of the person you spoke with at the insurance company? I'm wondering if you can go back to the doctor's office and call your insurance company from there and hand that woman in his office the phone. Or wait until your appointment and do it then? That would cut out waiting for the doctor's office to call the insurance company back.

As for the Subutex, unfortunately, there are many doctors who just will not prescribe it. Either fearful because of stories of diversion and there are some who have been erroneously told that the DEA will be all over them if they prescribe it.

It might be time to at least see if there are any doctors that take your insurance. I know it took you a while to find the one you have, but maybe there are new ones now. You can try asking your insurance company or looking on their website to see if they have a list or know of any.

Also call the Here to Help line 866-956-9204 and see if they can help you either with the insurance company/doctor office problem and finding a new doctor. Also sign up on the matching system and see if anything comes of that: http://www.treatmentmatch.org

I hope that helps. Let us know.

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 05-04-2011, 04:20 PM   #5
Selena15
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Posts: 161
Default

Hey,Jack and Nancy
Thanks for responding.

Jack at first i thought u were going to fuss at me for using the word shady.
I have thought about changing Dr. but I would still have the same problem with the Ins. Of course,maybe just maybe the office staff would help a bit more.

I left a message with the Ins. this morning. I'm going to ask them what can I do to move this forward. Or perhaps,if they could go back to the original PA that was sent. They can look and see I take seizure meds, and they can also see I've not filled any of my pain pills that still have refills.

Nancy,I'am a memebr of HeretoHelp and I have a coach as well.
Any help she could give me was some sites that could possibly help me with the Suboxone. Problem is,is that I have Ins.
I have spent so much time on trying to get this resolved that my nerves are shot. Not to mention the money I've had to spend on the Suboxone.

Thank you both so much for some feeback.

Selena
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