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Unread 12-23-2010, 02:55 PM   #1
JimB
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Default Have insurance but no doctor will accept it for Sub. treament.

Hi everyone. I have been searching for a doctor who accepts my insurance as payment for Suboxone treatment. I called my insurance co, which is UPMC for You, and asked for a list of doctors who have the privilege of prescribing. Suboxone for opioid addiction. They gave me about 20 names. For the next 2 days, I called all the numbers I received without any luck. All of the doctors on the list accept UPMC for You insurance, but when it comes to Suboxone treatment for addiction, they want paid in cash. I find all of this just incredible. It doesn't seem ethical to me...to accept insurance for payment in the treatment of all diseases EXCEPT Suboxone for addiction.
I have several disabilites, so I receive S.S.I. While I am so very grateful for all the help I receive, I just cannot afford to pay hundreds of dollars a month for Suboxone treatment. Especially since there are doctors who accept my insurance for everything except Suboxone treatment. Ugh!
So if there is anyone out there who is in SW PA and has UPMC for You insurance, and knows of a physician who takes this insurance to treat with Suboxone, would you please give me their name? I'm beginning to lose hope. I really want off the Methadone (I get it from a friend) without going through hellish withdrawal for a few months. I take care of my elderly mom. I am her sole caregiver. I know Suboxone with psychotherapy is my best chance to live a clean, normal life. Thank you for your help. And Happy Holidays to all!
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Unread 12-23-2010, 03:22 PM   #2
TIM
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Hi JimB,
You've discovered a widespread problem. When buprenorphine treatment was first approved for addiction few insurers paid for it so many doctors established a cash only policy. Since then most insurers cover it and many provide substantial reimbursement, yet some doctor still won't accept insurance. Normally ( like with ever other condition) patients can simply avoid those doctors and favor the ones who accept insurance, then as the cash-only doctors begin to see less and less customers, they would be forced to change their policy. That's normally, but with buprenorphine the government has stepped in and artificially limited the supply of doctors by regulation and patient limits, thus destroying the normal market forces that prevent the cash-only policies. With so few doctors who actually prescribe buprenorphine (about 1% of the ones who prescribe the drugs people get addicted to) patient can't simply find another doctor.

What you can do is get a receipt for treatment and submit it to your insurer for direct reimbursement. The claims department can get you the proper forms and let you know what paperwork you'll need to include. If you have prescription coverage just about all pharmacies will accept it and you won't need to get reimbursed for the medication from the insurer.

Welcome to Addiction Survivors!
Tim
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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. Voluntary Disclosure: Timothy L. is the President of The National Alliance of Advocates for Buprenorphine treatment. (NAABT.org) The views and opinions of Timothy L., or any poster, are not necessarily the views of AddictionSurvivors.org. NEVER take any online advice over that of a qualified healthcare provider Any information you read here should only serve to inspire you to investigate further with credible, verifiable referenced sources or your doctor.
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Unread 12-23-2010, 10:20 PM   #3
AbbyNormal
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I just don't get it. Why would physicians who take an oath to heal the sick, not accept payment from insurance? My guess is that it would be a smaller agreed to amount and there is good money from us addicts.

What a shame there are so many. My doctor (luckily) takes insurance at the adjusted rate which he bills at $150 and receives $85. Plus he spends a whole lot of time with each patient addressing every need. He says he does it for the good of his patients. This man ought to receive an award for humanity.

My problem will be that next year I retire and we're moving out of state and will need to find another Sub doctor for maintenance and tapering. We'll see...

Good luck finding someone. You'd think there would be one out of the 20.
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Unread 12-24-2010, 01:08 AM   #4
MissSurvivor
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I'm so sorry for what you're going through as we've heard many others go through the same thing - BUT DON'T GIVE UP! I would definitley see if you can get reimbursed as Tim suggested.

What mg of Methadone are you on?? Please know that if you do induct on Suboxone you have to be on 30mg or LESS (recommended).. otherwise there's a larger chance you will go into precipitated w/d. I'm sure a doctor would tell you this, but you never know. Education is power. I inducted off of 20mg of Methadone waited 50+ hours and had no problem.

Tim, I didn't know/understand doctors did a cash-only thing because of insurance issues. That's just ridiculous!! Doctors should help a patient in any way they can! Just to simplify the issue seems so 'off' especially for doctors. But I believe it! I wonder if certain states have it worse than others but I know that may be hard to find out.
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Unread 12-24-2010, 08:26 PM   #5
packrat
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I'm sorry, too that you are going through this.

I just wanted to ditto MissSurvivor with my own experiences:

My doctor refused my insurance flat and I had to pay cash for the doctor visits. My insurance paid for medication, though.

I had no problem with induction from Methadone, just get as low as you can (I wouldn't try inducing above about 50mg, though), stabilize for a week before starting. There is a specific protocol for such induction you can read at http://naabt.org/documents/PCSS_Meth-bupe-transfer.pdf. You really want to get off of street methadone, though as you never really know what you're getting especially if its the liquid from an MMTP.

Best of luck. There are a lot of smart, supportive people on this site who went through just what you are going through, so keep posting!

-Packrat
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Unread 12-24-2010, 09:22 PM   #6
JimB
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Hi everyone. First let me apologize for not getting back to you all sooner. This time of year is so busy, it feels like I don't have a moment to myself right now. But maybe that is a good thing. I don't have much time to think about the predicament I'm in with my addiction and inability to find a doctor who will accept my insurance for Suboxone treatment.
Tim, thank you for all the information. Before my addiction started, I had heard of Suboxone, but I had no idea what was involved getting access to treatment. It's been an eye-opener. Your idea about asking my insurance to reimburst me for any out of pocket money I spend is very good. Thank you. I will check into that on Monday. If I have to pay to see a doctor because he/she won't accept my insurance, I guess I'll have to manage it somehow. As I said before, I receive S.S.I. so my funds are very limited. Thankfully, my insurance pays for the Suboxone after receiving prior authorization. That's a life saver. I will find a way to receive Suboxone treatment because I have to. I cannot give up. I know it's not a miracle drug and that I must do LOTS of work in therapy, but I just can't face going through months of withdrawal, as you all understand. I made it through 3 weeks of Methadone withdrawal, and the symptoms were still getting worse. I gave up because I knew it was going to last for months. I take care of my 80 year old mother. She suffers from her own medical problems. I have to be strong for her. I'm her sole care giver. That alone is enough to motivate me to overcome this addiction.
Miss Survivor and Packrat, thank you for sharing your experience with Suboxone and Methadone. I have learned so much from this forum. I now realize that switching from Methadone to Sub can be difficult if it's not done correctly. To be honest, I am taking about 40 mg of Methadone almost daily. I need to taper that down to at least 30 mg for as long as possible (I think I read at least 2 weeks on the lower dose.) It takes me at least 4 days before I begin to go into withdrawal. Being deathly afraid of precipitated withdrawal, I want to be in withdrawal at least 4 days before I begin induction. So, for example, if I stop taking Methadone on a Monday, I don't want to begin taking Suboxone before the next Monday. Does that sound like a reasonable plan to you? I know nothing is guaranteed and each person's body reacts differently, I just want to make sure I give myself enough time to get as much Methadone as possible out of my system before taking Suboxone. I'm sure the doctor will help me determine what I need to do.
Again, thank you for all your support and information. It's been invaluable to me. I wish you all Happy Holidays and a wonderful, happy New Year. God bless.

~Jim
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