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Unread 11-09-2009, 05:09 PM   #1
JakeUNF08
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Default Why Don't Doctors Accept Insurance For Suboxone Treatment?

Hey Guys,

I'm very new to the site. Today is my first day. I've been trying to find a post related to question below, but I haven't had any luck.

Here is my question.....I live in Northeast Florida and have called about 10 doctors in the area that are qualified to prescribe suboxone. I found them by looking at providers covered by my HMO and then cross-referenced that to the list of docotors provided on NAABT.ORG. I have a great insurance plan that actually covers suboxone and addiction treatment. However, every single one of the doctors I called require you to pay out of pocket. They will not accept insurance for some reason. Does anyone know the reason for this? The cheapest doctor I found was $225 for the first visit and $95 for subsequent visits. Some were up to $500 for the initial visit. They said I could apply for reimbursement from my insurance company but they would not process a claim for it. Sounds kind of shady. Anyone else have this problem?

At least I can use my insurance for the prescription. I pay $40 bucks for 60 pills. I think there is a generic available so I'm going to try to get that next month.

Thanks for reading and taking the time to reply.
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Unread 11-09-2009, 05:44 PM   #2
JDK613
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Yes that is how it is w/drs not accepting insurance. I live i ohio and have found a few who will accept insurance but you still need to make sure that the dr understands addiction and is able to give you the best treatment for you recovery. I know my insurance will reimburse half of the cost, which is better then paying all out of pocket. I still have no idea why all drs won't accept insurance, it is their right and option to accept or not. Hopefully one day these drs will change their minds and accept insurance, they could be helping out so many more of us. Sometimes I think their philosophy is that if we can find $ to pay for our D.O.C. then we can find $ to pay them. I don't know but I do know it sucks! Not everyone has a $500 a day habit and/or just has that kind of $ laying around. When you're addicted it's impossible to save any amount of $ because you will use that $ just to stay out of withdrawals. But $225/$95 you found sounds like a fair price, it would be here anyway. And if you do pay-out-pocket and get reimbursed, you can just keep using that reimbursement $ to pay for next visits, if your insurance company is quick in processing your claims.
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Unread 11-09-2009, 06:07 PM   #3
OpioidsGotMe
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Quote:
Originally Posted by JakeUNF08 View Post
Hey Guys,


I think there is a generic available so I'm going to try to get that next month.

Thanks for reading and taking the time to reply.
Hi,
Just to let you know there is no generic for suboxone yet, just for subutex.

Darrin
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Unread 11-09-2009, 10:06 PM   #4
NancyB
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Hi JakeUNF08, there are some doctors who don't know what office codes they can use when filing (there are different ones for mental health, etc.), but unfortunately some doctors find it's easier to not file for insurance claims and just take cash. It's quite discriminatory when people going to the same doctor for, say, a physical, will have the claim made by the doctor.

Theoretically, if a doctor is in an insurance plan, they are obligated, by contract with that insurer to file the claims.

My suggestion would be to call your insurance company and tell them what's going on and see what they can do to help.

Good luck and let us know what happens.

Nancy
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Unread 11-10-2009, 08:30 AM   #5
JakeUNF08
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Thanks OpiodsGotMe. I guess I'm sticking with the Brand then. $40 really isn't that bad anyways. My real problem was the fact that my insurance agrees to cover the treatment and the doctors are not willing to process the claims for it.

Hasn't the patent on suboxone run out? Or am I wrong. It may just be subutex. I thought Reckitt lost the SUBOXONE patent October 8, 2009.
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Unread 11-10-2009, 08:42 AM   #6
OpioidsGotMe
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The reason they don't have a generic for the suboxone yet is because they are having trouble with the making of suboxone. I think it has to do with combining naloxone and the buprenorphine.

Darrin
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Unread 11-10-2009, 08:45 AM   #7
OpioidsGotMe
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But you are right. As of Oct 8 they were able to have the right to make a generic for suboxone and subutex. But as of right now there is just the generic for subutex.

Darrin
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Unread 11-10-2009, 11:34 AM   #8
ex-opiatelover
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i was always told if u cant say somthin nice dont say nothin at all! so im gonna be nice!! but i pay 200 dollars a month to see my dr! i pay another 250 dollars a month for my subs! i will gladly pay that amount to stay clean!! as a matter of fact i love paying that amount to stay clean! i wish insurance covered it but it dont! i know some of the people ive sent to my dr are complaing about the money! it makes me so mad how they can always find a problem with somthin, why cant they just be grateful for what they got? yeah the money is bad but most people will spend way more than the 450 dollars it requires to see my dr a month ! they will spend more than that in a week on there drug of choice! i dont understand, they always had the money when they were addicted, but now all a sudden they dont have the money to stay clean an to change their life? now thats a shady deal!
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Unread 11-10-2009, 11:47 AM   #9
NancyB
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Hi ex-opiatelover, do you qualify for the free med program?

http://www.needymeds.org/drug_list.t...&name=Suboxone

If you do, talk with your doctor about.

Nancy
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Unread 11-10-2009, 04:44 PM   #10
RCDAVE
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I guess I'm lucky cause My ins pays for visits and meds (unitd) Had to get approvel but it wen through. The down side could be hospitalization and other. they should realize that this is the cheap way out for them
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Unread 11-11-2009, 02:01 PM   #11
ex-opiatelover
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thanks nancy! i will check it out! how are u? havent talked to u in awhile, glad to hear from u!!
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Unread 11-12-2009, 08:23 AM   #12
JakeUNF08
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It's not a money thing at all ex-opiatelover. I don't have financial problems...It's the fact that I go to a doctor and he accepts insurance for every other service he provides except for Suboxone treatment. It just seems....well...wrong. Discriminatory even. And the excuse that the Dr. doesn't know how to code something....umm...come one. He's a professional. He pays a "medical coder" on his staff. A simple phone call or some other inquiry could clear that up. I'm an accountant and we have something called Continuing Professional Education where we learn about "new" accounting techniques. If we encounter something we don't know how to report...we can't simply leave it off the financial statements. Plus, Suboxone has been out for many years now. There must be information available for these guys.

And I'm very happy to have discovered Suboxone. My complaint is simply if there is a way to make things fair and more convenient...well then do it.
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Unread 11-12-2009, 08:30 AM   #13
Mike
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Jake,
Have you seen the recent thread about this?
http://www.addictionsurvivors.org/vb...ad.php?t=22942

it was posted in the main forum instead of here under cost-Insurance where it should have been posted.

Last edited by Mike; 11-12-2009 at 08:52 AM..
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Unread 11-12-2009, 08:32 AM   #14
NancyB
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Hi Jake, here's a list of codes from the PCSS that maybe you can give to your doctor and see what he says...

http://naabt.org/providers.cfm#PCSS
About the PCSS:
A National Mentoring Network for Physicians Treating Opioid Dependence.

The SAMHSA-funded PCSS is designed to assist practicing physicians, in accordance with the Drug Addiction Treatment Act of 2000, in incorporating into their practices the treatment of prescription opioid and heroin dependent patients using buprenorphine. The PCSS service is available, at no cost, to interested physicians and staff, to assist in implementing office-based treatment of opioid dependence with buprenorphine. The essential elements of the PCSS are a national network of trained physician mentors with expertise in buprenorphine treatment and skilled in clinical education, who will be supported by National experts in the use of buprenorphine and a medical director. Click here for more about PCSS.
Phone: 877.630.8812 email: PCSSproject@asam.org site: PCSSmentor.org

http://naabt.org/documents/Physician...gForOffice.pdf

Also, talk with your insurance company and ask them what you can do about it.

Hope that helps.

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 11-16-2009, 11:04 AM   #15
ex-opiatelover
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hi jake! im sorry if u thought i was pointing the finger at u! i wasnt i promise! i was talking about some knuckle heads that i know ! i was in no way trying to comment on your situation! when i read it, it got me thinking about a couple of the people ive sent to the sub dr! so im sorry dude, didnt mean anything toward u! but i understand addiction is a medical condition, so there for insurance could cover it! an i read your an accountant! thats what im going for in college! gone make the big bucks i hope!! i might get some pointers from u sometime!! good luck man!!
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Unread 11-17-2009, 07:25 PM   #16
mark123
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Hello,
I am sorry to disagree with some people, but I think a lot of doctors out there see the Sub game as a way to make a large amount of easy cash. They only need to go through a certification program and once that is done they can open their doors and the family doctor who might know nothing about addiction and maybe even actually hate addicts can now treat with Sub and pretty much charge whatever they want.

The addict is desperate to get help and once on Sub, if you do not live in a city with a lot of Sub doctors, you can't just walk away if the doctor turns out to be an ass or decides to double his or her price for a 2-minute office visit and the time it takes to write a prescription. I understand about record keeping and overhead and paying a receptionist or nurse or whatever, but come on, what a racket!

I have noticed that lately a lot of doctors are extremely paranoid about the FDA and the FDA has been doing checks. My doctor looks at my medications and says you are on too many mind altering things. Two I can justify, but not 3. I am on:
1) Subutex - 24mg per day (yeah, you might think it is a lot, but I have a 30 yearhistory of addiction including 3 years on methadone.

2) Adderall 30mg per day. I have moderate to severe ADD. Bad enough to constanly make me forget things, even my job skills I have been slowly forgetting. This has been going on way before the Subutex and even when I have been totally abstinent of all mind altering and any other medications. I lost my job in June because I could no longer do the work. I see an addiction specialist and a psycologist and they both diagnosed me with adult ADD. I swear, I though I was crazy or had Alzhiemers. I was terrified out of my mind that I couldn't function. Looking back over school I had periods of good grades, but mostly very poor. I never fisnished high school and had to get my GED and at age 34 after being sober 5 years, I went back and got my bachelor degree in computer information systems. I had to study 10 times harder then everyone and a couple of classes I got a C-.
3) Lastly, I am on 1mg of Klonopin a day for horrible anxiety.

I am sorry for the long post and in-depth explainations, butmy point is the medications I take are helping me now. I function like a new person and am hoping to get work soon.

The doctor told me it doesn't look good because you are on 3 different mind altering medicines. Then he said, "If you were a cash patient and paid cash for your medications then I wouldn't care at all." It is the FDA. I am worried about the government.

Because of this, I now pay cash for my Adderal instead of running by my insurance, (COBRA).

So here I am unemployed, I would be paying $600 per month for COBRA, but thank GOD Obama put some kind of 2/3's subsidy for the first 9 months of unemployment, or I would be screwed.

My doctor's visits which last about 2 to 5 minutes cost $200 per month and now my medications are about $370 per month since I have to pay for Adderall with cash.
Everything I get is generic except the Subutex. I don't think that is available yet. With my insurance it costs $80 per month anyway.

Every month either my mortgage or HOA fees are late and I have to borrow money from family. I have been doing side work for my ex-brother-i law, who is a doctor and owns an urgent care clinic. I work on their computers and that has kept my head above water barely. He is totally against me being on Subutex or any other mind altering drug because he thinks abstince is the only way.

I am sorry, but the way things are regarding Subutex and treatment as far a cost is ridiculous! Someone said these doctors may have an attitude if they could afford to get their DOC then they can pay for treatment.

How stupid! Most junkies end up stealing and doing illegal things to get their DOC, so obviously they could not really afford their past drug habit, not legally.
Besides people get into treatment to get their lives together and being able to be financially stable and self supporting is part of it.

I grew up in a generation where people went to medical school because they wanted to help people. I am not saying everyone did, but most. Now, all the doctors seem to care about is $$$. I have been to a few who really could care less if I lived or died. Believe me, I can tell when they really care and want to help or just see me as a piece of meat and a $ sign.

I had to get my 2 cents, (well maybe 3 cents), in.

Thank you.

Mark
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Unread 11-18-2009, 01:38 AM   #17
JDK613
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Woh! You said it Mark!! I totally agree w/you! I had been told by the 1st sub dr i went to, and quite often, that if we can find a way to pay for our doc then we will find a way to pay for sub treatment. Which just led me to believe that most sub drs had that attitude. To some degree I did agree w/him but you are right when you say we would do anything to pay for doc, we shouldn't have to go to those lengths for legal medical treatment! But don't get me wrong, he was a good guy. He would set up payment arraignments w/us and he would say 'that's just the nature of the business' I just had to find a dr who accepted insurance because you are right, they want to blame it on coding?? Come on!! What a poor excuse and what about the few drs I found who do accept insurance? They're the only ones smart enough to figure out what code to use-if that's all it is then why couldn't we offer to call our own insurance company and get them their code?? I don't know. I feel like they prey on us, they know our desperation and they use it for their financial gain (not speaking of all, there are some in it for the right reasons). Most of us aren't even using to get high we just can't take the withdrawals, we just want to feel 'normal'. But I do think in time more and more drs will come around, at least I hope.
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Unread 11-18-2009, 10:14 AM   #18
ex-opiatelover
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i agree mark! most dont take sub to get high, we take sub to not be sick an feel like a normal person! but i also agree with u about the money they make, every time i go to the dr he is driving some sort of a sports car or a pimped out truck! not really what i picture a dr would be driving, but i guess its his buisness!! it does kinda bother u when u know your money is going to help his celebrity lifestyle! but anyway very good points made by u an jdk! i to felt my dr could care less if i made it or not! when i screwed up, an by that i mean i ran short on medicine the first two months! i was on as ive said many times on here, 15 to 20 pills a day for 5 years! an all he prescribed me was 8 mgs! 1/2 in morning an 1/2 in afternoon! i didnt feel like it was enough! i told him that an he wanted to kick me out of treatment! he did actually, but i begged to be let back in treatment! but once i started doing an saying what he wanted me too, things went alot smoother! so i truly wish these sub drs would be a little more understanding about everyone situation, because everyones situation is different!! in the long run, i am thankful for these drs, caus they saved our lives, or well they give us the chance to change our lives!
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