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Unread 05-16-2008, 01:12 PM   #1
TIM
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Default Pre-authorization problems with insurance?

Has anyone had to have pre-authorization by the insurance company to begin bupe treatment? If so what insurance company required this.
Thank you.
Tim
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Unread 05-16-2008, 11:02 PM   #2
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Here's why I was asking:

Critics Say Health Plans Put Lives at Risk by Requiring Prior Approval for Buprenorphine
http://www.jointogether.org/news/fea...plans-put.html
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Unread 05-16-2008, 11:47 PM   #3
theswan
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Hi It just happened to me. My Workers comp paid three times in a row and then balked for "pre-auth" It went through after the pharmacy called.

It is a real pain as I have to sit on the edge of my seat each each month. I had anxiety for two days as I was running out. I am going to try and cut back 2mg each day to save enough. Funny thing is I do not feel addicted to sub and do no "clock watching" but when they denied me for a "pre-auth" I was on edge. Who needs to have W/D start? Darn these people anyway.

Theswan
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Unread 05-17-2008, 12:00 AM   #4
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That's terrible theswan,
When someone reaches out for help with an addiction disorder, help needs to be quick, otherwise there is a chance the patient will disengage from treatment. There is no reason that your medication need to be the source of any more stress. Not thinking about the pills is part of what addiction treatment is about. This company that is doing this is not putting the patients' needs first. I'm thinking of trying to make employers realize that choosing a health plan for their company that covers addiction, is a smart choice. Then once employers stop purchasing plans that don't cover it the insurers will change.
Tim
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Unread 05-17-2008, 12:03 AM   #5
theswan
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Hi Tim


I'm stuck with them as it is an assigned workers comp provider. It may not happen next month.

Thanks

Glen Theswan
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Unread 05-17-2008, 12:10 AM   #6
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It would be nice if they could tell you for sure. Nobody needs that extra stress. I remember someone posting about always being worried his doctor was going to ask him to start tapering. he would stress about it before each appointment. One day he just decided to ask and the doctor said , "you can sty on as long as you need to" a month later he asked the doctor to start to taper. by not having that stress he was able to progress to the point where he felt comfortable beginning his taper. it just shows how stress and anxiety with treatment does no good.
Tim
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Unread 05-17-2008, 01:47 AM   #7
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I had Blue Cross of California when I first started bupe. They wanted a pre-authorization, then they would only pay for 10 subutex, (I found out a week latter) even though it took 23 to get stabilized. Since it took them a very long time to approve the pre-authorization, I had to paid out of pocket. They did pay for suboxone so that was nice, once I was switched over. I have been in cases where I just could not wait another day, it was a miracle everyday we managed to keep it up.
I used to pray to God "Please let us make it through until we can get out of this."

Funny thing Blue Cross of Minnesota did not want a pre-authorization for subutex.

I can not see any reason to need a pre-authorization for bupe, having one is simply a tactic to deny care to opioid addicts. IMO it is a form of discrimination. They know that many patients are not going to be able to wait until it's authorized. Since bupe is a little on the expensive side, they figure their saving money. Addicts and their families are willing to pretty much anything. It's sick and wrong in my opinion.

Thankfully I have different insurance today, as at some point I developed a sensitivity to suboxone and went on subutex. I feel so much better now and have for such a long time, it must be like two months now. So I'm sure it was the suboxone. Last time the doctor said I was one of only two patients with the sensitivity he has seen so far.

Wow that brought up some nasty memories, it's good to remember or I start to think I don't have a problem.

I just read the article, I hope they get sued, they diserve it so badly. I wish they could throw the people who came up it that plan in jail. It makes me so mad.

Smith
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Unread 05-17-2008, 02:48 AM   #8
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Hi Tim,

I think you might have seen this in another one of my post but I wanted to get this info. to you.

I have Health Net of California and for my suboxone they require prior authorization. So, I of course am having alot of anxiety over this as I am starting my suboxone treatment this Wednesday. After my induction in the doctors office he will be giving me my prescription and I will be going straight to the pharmacy to get it filled. Of course I am going to have to have the medication right away for the next day. So what am I supposed to do??? I have no idea how long it takes to get the pre-authorization.

Also, because there is no provider in my health network that does suboxone I have to go to an outside network provider. I was told a couple of weeks ago that all I needed was a referral from my Primary care physician and that was also the authorization to see an out of network provider. Well of course I have my appointment with the suboxone doctor all set up for next Wed. and cannot wait to go and get started. So today I go to my primarcy care doctor to get the referral taken care of and am told by my doctors office that they have to send it in for prior authorization before I can see the suboxone doctor and that could take anywhere between 3 days and a couple of weeks. I cannot wait this long and don't want to. I have been waiting patiently to get started on the suboxone. I can't cancel my appt. this coming week. They also said that if I see the doctor before they get the authorization then the insurance won't pay the claim. Also, since it requires prior authorization they can't even give me the referral. I am so messed up and confused. I have no idea what to do.

All help is so greatly appreciated.

Thanks
Chris
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Unread 05-17-2008, 04:33 AM   #9
Smith
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Chrisifix

This is what I suggest.

Call around now and find a pharmacy that excepts your insurance that carries it in stock, it may not be easy. Try looking for pharmacies on this site (http://www.naabt.org/patient_doctor/splash.cfm) but don't count on it, call them in advance. When you get to the pharmacy if you can not get the whole thing filled try to get a partial fill of just what you need for a few days. Then if the authorization goes through you can fill the rest. It's expensive but you probably can afford a few days worth.

In the future save up a stock pile so you will have time for the paper work to go through.

How much is the sub doctor going to cost you, it should not be more than $200 if it's more that's ridiculous. You have to do what you have to do. Try to do what you can but if you have to you have to. You life is more important then a few hundred dollars, how much where you spending on you drug of choice?

Once stable you will have time and be free to work out the insurance stuff, if you can not find a doctor then try to just find the one you can afford. Also don't feel afraid to tell the doctor that cost is an issue for you. Especially after having a opioid misuse problem. They can often give you a discount. Some doctors even here in LA only charge like $80 a visit. After the fist few days you can often reduce your dose to help make it more affordable.

Best of luck to you and keep us updated, many of us do really care.

Smith
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Unread 05-17-2008, 01:01 PM   #10
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Thanks for sticking up for us Tim

"Tim Lepak, president of the National Alliance of Advocates for Buprenorphine Treatment, said that while buprenorphine patients are "really happy to see that more plans are paying for [the drug]," including Magellan, Blue Cross/Blue Shield and Cigna, he said that requiring preauthorization will prevent some patients from getting treatment. "They're putting patients' lives at risk," Lepak said."
http://www.jointogether.org/news/fea...plans-put.html

Sarah
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Unread 05-17-2008, 07:26 PM   #11
Chrisifix
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Smith

Thanks for the input. That is exactly what I will do at the pharmacy just pay for a couple of days worth and wait for the authorization to go through.

I think I am actually getting a pretty good price for seeing the doctor. It is $115.00 for the firt 7 visits and then after that $70.00. Right now I am not going to stress about any of the money and insurance part. Getting started on the treatment is the most important thing to me right now.

I am very grateful for all the help and input I get here. Thanks

Chris
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Unread 05-18-2008, 05:49 AM   #12
Smith
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I think this a good plean. Oncce you are stable you can then work on something else to help get insurance to go through. Don't forget to build a stock pile up for time when it doeses not go through,

Hope alll is well.

Smith
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Unread 05-22-2008, 02:53 PM   #13
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TIM,
I just switched from the empire civil service plan in NY to Oxford. They required a pre auth...unknown to my until the pharmacy called me. So I ended up paying $170 for 30 8 mgs just to get them filled, because I was out. I don't share that I am on this treatment with my sig other, so trying to come up with $100 for the Dr visit and $100 plus for the script is so difficult for me on a monthly basis! So to be honest with you (and to show what the results can be) I wrote a check...knowing I didn't have the $$ in the bank. I am not proud of that. I will get it in before it bounces, or on the second submittal, but I felt I had no choice. I had been running low for the week and was taking 2 mg to my usual 8mg just to stretch it out, again because of $$..and I was out. I can't afford to be sick, I am a working professional with 4 lovely children (young)...so I felt writing that check was the less of two evils. Why do the insurance companies and even the doctors have to charge so much,...to make it even more difficuilt for an addicted person to get help? My doctor is in Brooklyn, he is wonderful...but he will not accept insurance for my visits (even though I have good coverage). I just pray that as time goes by, this treatment gets less expensive!
Sue
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