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Unread 04-21-2009, 02:08 PM   #1
vikkivallencourt
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Unhappy PA and Medical Assistance

I live in a town about an hour from pittsburgh. It's a small town, with BIG addictions. It went from vikes and perks to oxys and now Heroin has taken over. There isnt ONE person in my life that doesnt know SOMEONE who is addicted. It's HORRIBLE. When I was younger, smoking pot was the worst anyone did. I wont launch into my life story here, thats another post. I have been receiving sub treatment from a doc for about 10 months. At first I did great, but lately, I am relapsing CONSTANTLY and I dont understand it.
My biggest problem since the beginning has been the cost of it. More recently, my husband (over the road truck driver) was pretty much layed off. He is still working but his pay went from $1000 a week take home to $300-500 a week. With the constant worry about bills and money, I am beginning to feel completely hopeless. My dr charged me nearly $500 to start therapy, and I am now payin $75 a month plus gas to drive 60 miles round trip (Durango's eat a LOT of gas!). I have spent 6 of these 10 months searching for some way to get this treatment and pay NOTHING. I have called every physician in 3 counties, NONE will take medical assistance or the behavioral health plan for sub visits. The insurance companies, the workers at the assistance office, the county mental health people, you name it i've called them, NOT ONE OF THEM seems to know how I can get the treatment paid for. Now, heres the kick in the rear end.....
I have read both the UPMC for you AND Value Behavioral Health plans & policies......BOTH OF THEM COVER SUBSTANCE ABUSE OUTPATIENT services. So, WHY is it that I am STILL paying? WHY will they not give me back the nearly $3000 that I have put into this? (I was self paying meds for a while, thankfully I dont have to do that any more!)
Is there anyone who has gone through medical assistance in PA that can tell me what I have to do?
I am TERRIFIED that I will not have the $75 next month to pay for my visit, and just what do I do then? I have my childrens needs that have to come first, and this month, I felt lower than low when I had to actually pawn jewelry to afford this.
The ONLY place that will do the treatment for free REQUIRES me to go to therapy AND group therapy 3 times a week totaling 5 hours each night......I DONT HAVE ANYONE to watch my kids, and I cant take them with me. AND my kids have services that come to our house for several hours a night, I CANT TAKE THAT AWAY FROM MY KIDS!
THIS IS HORRIBLE and I hate it. Why is it that when I try to do the right thing, the world kicks me when I am down?
WHAT DO I DO? PLEASE HELP!
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Unread 04-21-2009, 05:52 PM   #2
NancyB
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Hi vikkivallencourt and welcome. Did you submit the right forms and receipts from the doctor visits to the insurance companies? What was the reason for not reimbursing you?

Here's the contact web address, see if you can get any answers through phone calls and email. http://www.upmchealthplan.com/plan/a...e/contact.html

Keep us posted.

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 04-21-2009, 11:13 PM   #3
monica
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Hi There,

I just want to say do not give up hope because there is help available. I live in PA and have Pa medicaid UPMC for you. They will cover the doctors office visit and your medication. The only thing is that the doctor has to accept upmc for you and you will have to more than likely make this doctor your pcp (which is easy). There is one doctor that I know of who accepts upmc for you and he may still have openings available. The dr is located in Turtle Creek, Pa and his telephone number is 412-829-7019. Call to see if you can get in. This dr accepts upmc for you for office visits and the medication is covered with the exception of probably a $3.00 co-pay.
Also, use the physcian locator. PA medicaid is very good with this and there is help. You need to try a little harder because relapse is not an option or an answer to your problems. If you can afford the time and money to relapse, you can take a little more time to find recovery.
Good luck and Best Wishes to you.
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Unread 04-25-2009, 10:17 PM   #4
toboat777
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Ther is a person new here that posted on the wrong site. (Name is True Blue scared i might. ) I believe he needs guidence to the right site i attempted to give him the info, to insurance site and main forum but was not able to post. ??? Thanks Tony.
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Unread 07-01-2009, 10:29 AM   #5
comingbacktolife
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Default PA and the cost of suboxone treatment

Hello there vikki. I just wanted to post a response because I completely know where you are coming from. I live in PA as well, but on the other side of the state, so unfortunately, I can't recommend a doctor around where you live. I have been on suboxone since last may(this time around), and have been successful thus far. I know how you are feeling with the job loss, expenses, let alone medical expenses.
This isn't my first time on subsoxone, but it is my first time being as successful as I have been, and part of that is due to finding the right doctor. I read a doctor charged you $500 for the initial visit.? That right there is an indicator to me that the doctor is in it for the money, not for helping addicts. Most inductions usually are about $200-$250, as far as I have ever experienced, and follow ups usually are $75 monthly. It took me a few doctors before I found the doctor I am currently under the care of, and fortunately, I was his first patient-and an informed patient at that. I knew of the program from RB, the manufacturer of Suboxone, where if you meet certain eligability requirements, you receive your suboxone for free, sent directly to your doctor's office. I don't know if you are aware of the program, so that might be something to take a look at. Another thing that is strange is that they don't accept your MA. I was under the impression that doctors in PA did not accept it, however about 2 visits ago, my doctor was telling me how he has a lot if his patients paying with MA, and also filling their prescriptions with MA as well. I told him no way, but there is no reason for him to lie.
All I can say is check into the program from Reckitt-Bensicker, and if I were you, I would look into another doctor. If there is an increasing problem with heroin addiction in your area, chances are more and more doctors are going to complete the course so they can prescribe Suboxone. After all, they do make money off of it, and unfortunately this is some doctors only reason for doing it. Also, check further into your MA. Like I said, I live in PA, and my doctor accepts it for payment, and told me the patients he has that have MA get their prescriptions filled using it. I do know that some doctors will not accept MA for payment, that is up to their discretion, but there are some that do.
I wish you the best. Try and keep positive, believe me, I know how hard it can be, especially under circumstances beyond your control. I lost my job last year and can't find work for the life of me. I couldn't imagine if I had to pay for my medication, I would have no money left, quite possibly not even enough for the Suboxone, let alone other medications I am on. There are some days I get so frustrated about the job situation it's just like man, I just want to feel nothing, but I have come so far in the last year, after a 12 year battle with H, this is the best I have ever been. So yeah, times are rough, but at least I'm not waking up sick as a dog as soon as I open my eyes, worried about scoring and the whole rat race. I am tremendously grateful for my chance this time around. Oh by the way, RB patent is up in August I believe, which means a generic version is not that far away, which would obvously lower costs.

Last edited by comingbacktolife; 07-01-2009 at 10:33 AM..
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Unread 07-01-2009, 01:58 PM   #6
csdmommy
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Just to clarify a little point for everyone, just so you guys will know. Doctors do not have to accept medical assistance/insurance plans. If they choose to, then they have to accept EVERYONE who comes it with that certain type of coverage. They cannot cherry-pick among their patients, ex: only see females with MA, or children w/ BCBS. That is illegal and the doctor would have to answer for it.

Once the doctor is a participating provider (a physician which enrolls in a certain insurance plan or assistance program to be designated as a preferred physician to receive more patients) then they accept everyone under the plan they choose to participate through. Then, if the doctor refuses to see a patient due to their insurance AND he/she is a participating, then the patient has the full right to call the insurance/assistance program and report the Dr.

If the physician is not a participating provider, then it is the patient's responsibility to pay the charges in full. The exception is if the doctor's office provides any sliding scale services or any other various and sundry discounts.

Hope this information helps.

-Christy
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Unread 08-27-2009, 01:26 PM   #7
blueidblondie
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Default DOCS who take UPMC For You

I am in the same position as the original poster. I live about an hour outside of Pittsburgh as well. I have been taking suboxone and have been clean and sober for 3 1/2 years now. At first, I started treatment at a detox facility then to in-patient and eventually to out-patient therapy, as well as receiving suboxone. After about 6 months of all the previous hooplah, I eventually graduated to just being able to go to the doctor, monthly, get my suboxone script filled and that was it. BUT- I have had doctors ween me down to nothing and I get sick when I do not take sub for a couple days- eyes water like crazy and yawn, yawn, yawn.. So, having UPMC For You and VBH as well, I have had to bounce around a lil when weened off or a doc moved, and I know a little about some doctors who take this insurance, do not make you go to groups or any additional therapy, and the only thing you pay is $3 for the co-pay on the subs at the pharmacy..

Not sure if you found a doc but here are some that I know take UPMC For You and like I said, you will only have to go, monthly, pay $3 for the script and that is it. I live north of Pitt, about 45 minutes north, and all the doctors listed below are within a 1/2 hour drive from where I am:

Dr. Brayer... Natrona Heights (off 28, right off the NH exit, on the left) (724)
226.1400

Dr. Evanko... Suite A 160 Medical Center Road, Chicora (724) 445-3720


Dr. Martin.... 311 N 2nd St Apollo (724) 478-3766‎



Try these. I think Dr. Martin is full and not accepting patients now. Dr. Evanko will gradually taper you off/down (like 2 mg every month after first 3-6 months). Dr. Brayer is open, as far as I know...


I need to find a doctor that takes UPMC For You that is not one of the above, as I have already went there and received treatment... if anyone knows of any doc in/around the Pittsburgh area, heck in Western Pa-anywhere- please, please post and let me know!! I'd SOO appreciate it, as I am on my last 1/4 of a script of suboxone from my last visit and need to find a doc that takes my insurance ASAP- before I run out of my meds!!! TY and I hope this helps for anyone that may be in a similar situation...
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Unread 09-24-2009, 08:00 PM   #8
DARKEYES
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If you live only an hour from pittsburgh, why not try Dr Arthur David. He takes UPMC insurance, and usually you don't have to pay anything, at least that's what is nurse told me. I too have UPMC for life, the only thing is I have a terminial illness and had to change PCP'S to go to him. Try Callin him, you can get his number from this site on the matching site, just put in 5 miles from Pittsburgh. the G TWENTY SUMMIT town. He's wacky but good. now yunz all know where I'm from. DA BURG. STEELER TOWN.tHE SITE HERE MATCHED ME WITH HIM!!!! I have to travel a little but to me he's worth it, after induction with him, he assigns you to one of his other doctor's, that is why he can take up to seven new people a week so far, there is a group meeting after you dose. Please try him and if you need more info on him. oh THERE is a group meeting the first day with him, so plan on being there about 4 hours.


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Unread 09-25-2009, 10:53 AM   #9
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Oh by the way the group is only the first day, after that it is smooth sailing. Dr arhtur david, forbes and marion, pittsburgh.



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Unread 05-10-2011, 04:23 PM   #10
extreme_hate
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Thank you for the info. Darkeyes. I actually called and was able to receive an appointment with Doctor Arthur David on Friday. Can you tell me a little about his practice? Does he taper you slow? Also, the receptionist said that seeing as how I would be paying cash, that Subutex would be an option for me too. Do you know if this is true?
Thanks!
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Unread 05-10-2011, 04:55 PM   #11
NancyB
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Hi extreme_hate, welcome. Here are a couple of threads about DARKEYES's doctor that might be of interest:

http://www.addictionsurvivors.org/vb...ad.php?t=25899
http://www.addictionsurvivors.org/vb...ad.php?t=25794

Hope that helps! Let us know if you have any questions also.

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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