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Unread 12-15-2010, 11:51 PM   #1
tarancognita
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Default Illegal to pay cash for dr visit & ins. for meds?!

Hi everyone, I'm brand new here. I've already gotten some good advice just from reading around tonight, so...
Without going into too much backstory and detail, I've been on suboxone for about a year now. I have Medicaid (under an HMO) but am seeing one of those doctors that don't accept it, yeah, thanks a lot buddy. He just informed me that he won't see me anymore because I've been paying cash for my appointments and using my insurance to pay for my pills, which he says is illegal.
I know there are tons of people who have this same setup, so I called the here-to-help line, and the guy I talked to said he'd never heard of such a thing!

Then there's this whole part about how extremely weird they were there, really uncomfortable feeling, if I called with a question the assistant/secretary lady would be sooo rude to me, even hung up on me when I was trying to find out why the dr wouldn't fill out a form from my ins co! The dr was the same way. the one time I called him with a question he got on the phone and said "Sorry, there's nothing I can tell you. I wish you well." Those are almost his exact words, and that was it for my answer. Come to find out, this dr has been reprimanded/disciplined by the medical board or whatever (it's been a while since I found that, cant remember details right now) in both IL. and WI., where I am.
So aside from how shockingly rude and unprofessional they were to me, and sorry for the rant, has anyone ever heard of this cash/insurance issue? Can this be true? If so, wouldn't there be an awful lot of people who could get in trouble?
Anyone have any ideas on how to find out what the real deal is? I have already tried my HMO, they didn't even seem to get what I was talking about.
Thanks for reading, and I am almost a total newbie to forums, so I apologize if my post is too long or for any faux-pas, present or future.
peace,
tara
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Unread 12-16-2010, 06:29 AM   #2
NancyB
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Hi Tara, if he accepts your insurance for everything else in his office except for Suboxone treatment, that could be why he's dropping you. Call your insurance company again, and if the person you talk with this time doesn't get either, ask to be transferred to someone else until you get an answer. You can also see what your State Insurance Commisioner's office has to say:
http://www.naic.org/state_web_map.htm

Have you found a new doctor yet? Here's a thread with ways to if you need it:
http://www.addictionsurvivors.org/vb...ad.php?t=21259

Let us know what you find out, something just doesn't sound ethical there...

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 12-16-2010, 09:38 AM   #3
MaJaBe
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Hi Tara,
I had a similar experience when I was in active addiction. I was going to pain management, and paid cash, because they didn't accept any insurance at all. When they found out that I was using my Medicaid to pay for my pills, they were upset. They even discouraged me from using big chain pharmacies! The doctor told me "This is why all the pain management clinics are getting shut down". Because of Medicaid.
Of course it's not because of Medicaid, but by using Medicaid, the state is able to see what doctors are prescribing what medicines more easily. It is CERTAINLY not illegal to use your state insurance to pay for ANY medicine. It's probably just more of a pain for the doctor, because he feels like the state will be in his business. That may be a sign of a not so great doctor, so maybe this all happened for a reason. Doctors that are doing shady stuff typically don't like people with Medicaid, in my experience.
You deserve better. You're trying to get your life back!
I would definitly look into getting a new doctor.
My sub doctor doesn't accept any insurance for addiction treatment, and my medicaid will not pay for my subs, so consider yourself lucky that your state does, and I'd just use the matching system to find a new doctor, if it was me.
Good luck, and don't give up!
Best,
J
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Unread 12-16-2010, 12:20 PM   #4
mlk_2900
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I don't much about this issue in particular, but wanted to share my personal experience. I don't have Medicaid, but I do have Blue Cross and Blue Shield insurance and use it to pay for my medications. However since my doctor doesn't accept any insurance I pay him with cash or check. My doctor personally knows I do this and has never mentioned any problem with doing it this way. So it sounds a bit shady to me and doesn't put him as a doctor in the best light. This may very well be a blessing in disguise and in turn maybe you will find an even better doctor who will truly be there to help you and whose staff will not be so rude.
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Unread 12-16-2010, 02:09 PM   #5
tarancognita
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Thanks for responding!
Yes, this Dr. does seem shady & unethical, I felt that way from the first visit, but you know how it is...you need your meds and you end up feeling like you gotta keep this dr. no matter what! and I totally got the feeling that they were just trying to get rid of me because I have Medicaid.
Nancy: from what he told me when I first started seeing him, he does accept Medicaid for some people, but had reached some limit and couldn't take on any more Medicaid patients. I don't know whether that's for real either, but I mean to find out. I will certainly try both avenues you suggested.
MaJaBe: I really feel for people who have to pay cash for the whole thing; I look at the receipt from the pharmacy every month and see how much my RX would cost without Medicaid and count my blessings.
mlk_2900: you're right, it probably is a blessing in disguise, I felt so upset after every appointment with him because of how he and his staff treated me, and how sketchy it felt- if my appointments with him were 7 minutes long I'll eat my hat. "Here's your drugs, now take a hike"
I have found another dr., seeing him tomorrow, Friday. I used to see him and switched to the sketchy dr. because he charged less...you get what you pay for, I guess! The "new" dr. is very professional, and a real nice guy, thank goodness.
The bad part of that is I ran out of my suboxone already. I stretched it out, taking only 8mg instead of my usual 16 for 2 days, then yesterday and today I'm out. So I have to make it until my 3:30 appt tmw. I don't know if it's in my head or what, but I don't feel very good, and anxiety thru the roof. ugh. I wonder, if this guy turns out to have been dealing with me unethically, if I have any recourse for having to go thru this. Kind of speculative at this point, but I'm angry.
Thanks again, you guys. In addition to the good advice, I never have anyone to talk to about this stuff, so I'm really glad I decided to join this community.
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Unread 12-16-2010, 02:49 PM   #6
NancyB
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Hi Tara, I'm glad you have the appointment tomorrow. It will be so much nicer to be treated as a patient. The only limit that Suboxone doctors have is the general patient limit. 30 patients if they've been certified less than a year; 100 when over a year. I would definitely find out what his story is. Maybe he tells everyone that so he can charge cash...

Another thing is that Suboxone has a long halflife, and many people don't feel withdrawals for 3 or 4 days later at the 16 and 8mg amounts. So, just think that way and see if that helps to figure out if it's in your head as you mentioned. But 3:30 tomorrow is coming up fast. Just hang in there!

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 12-16-2010, 05:15 PM   #7
tarancognita
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Yep, after tomorrow, when I can think of something other than how I'm out of suboxone (heh heh) I am going to do some investigating.
I think most of my discomfort is anxiety. I had read about the halflife of suboxone before, but I'm glad you reminded me of it, that does help. I've got chills though, sort of like when you're getting the flu or something, which is pretty familiar from other withdrawal experiences...Do you think that having halved my dose for 2 days before being completely out could cause that, or would most people not even feel the difference? oh well, nothing to do but wait it out, and it's not really that long to wait now.
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Unread 12-16-2010, 05:45 PM   #8
DARKEYES
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Hi,
I paid cash for about three months until I found a new doctor and my insurance paid for the meds, no problem. All I did was call them, (the insurance co) and they got the meds authorized for me. Now with the new doctor he takes the insurance and my co pays are very low. Good luck.
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Unread 12-17-2010, 09:44 AM   #9
MaJaBe
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You may have some discomfort from lowering your dose a few days ago, but hopefully it's minor, and like Nancy said, it will be over soon! If it were me, I'd try to take a nap or something to kill some time, and if you can't sleep, watch a movie or take a walk, do something Christmasy, hang out with a friend, work, something to keep your mind off it!
Good luck today!
J
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Unread 12-17-2010, 10:51 AM   #10
NancyB
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Hi Tara, in general, even at 8mgs, many don't feel any withdrawals for a couple of days; but there are so many variables - even absorption rates - that it's hard to really know what was going on.

Let us know what happens today. Hopefully you were able to sleep last night.

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 12-23-2010, 02:18 AM   #11
wonmoreday
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When I did have insurance I too paid for my meds with my insurance but my MD was not on my plan so I always paid him out of pocket. I have confidence in my MD and feel they would of told me if the actions were illegal. Find out the truth by asking around or looking up your state laws. thanks for the info.
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Unread 11-13-2011, 07:30 PM   #12
Patrick84
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It is legal to have a Suboxone CERTIFIED doctor to receive payments and not accept whatever insurance carrier you might have because a lot of "behavioral health" issues are NOT always covered, say like seeing a psychiatrist not "covered by your plan" but where you need an anxiety medication filled under a certain insurance carrier. It IS NOT illegal to use your insurance to pay for a medication a licensed Suboxone doctor prescribes as long as YOUR insurance states to COVER THAT PARTICULAR medication, period. It doesn't matter WHAT pharmacy you go to either. It becomes illegal when you go to two different doctors and pay cash and then go and fill the meds simultaneously at 2 different pharmacies, one with your insurance and the other "out of pocket" or something really shady like that. These are the people who are making it difficult for those of us who actually take our medications as prescribed and are trying to get helpful and cooperative treatment, irredardless of duration or doseage. This is also where and why "pre-authorization" has now become an "issue" with some insurance companies before you can fill your medication for Suboxone, Subutex, etc. It really pisses me off that those of us who are respectfully and honestly trying to manage our lives are getting the shaft along with those who actually have been dishonest and are abusers of the system, we have all been thrown into the same boat. I am also tired of a dirty loof from some pharmacists who think that they can lable you a "junkie" because you are on the medication to begin with. No I don't lose sleep or dwell on it, I am expressing an opinion and observation. Ok I am off my soap box now.

Last edited by Patrick84; 11-13-2011 at 07:37 PM..
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Unread 08-03-2012, 01:52 PM   #13
peterjb1987
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i hear you... that pharmacy look... at least we are bettering ourselves. if they want to have a stigma, then, oh well... but yea it pisses me off too!
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Unread 08-03-2012, 01:57 PM   #14
peterjb1987
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im self pay now, and my docs office doesnt accepy medicaid... im not on medicaid yet, but that is wierd why he wouldnt want to see me if im on medicaid. the secretary said medicaid doesnt pay for suboxone, wich i know isnt true... howd ur doc find out?
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Unread 08-24-2012, 09:03 PM   #15
angrysubuser
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Red face VERY angry with my Dr. and don't know what to do..

Post moved to new thread:
http://www.addictionsurvivors.org/vb...ad.php?t=27961
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