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PostPosted: Fri Apr 15, 2016 8:59 am 
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So I've been going to the same suboxone Dr for about 2yrs. And I have MI medicaid. And up until about 7mos ago, I never had a copay because with the type of insurance I have I'm not supposed to have a copay for ABYTHING whatsoever. Well one visit last summer I was told, at the end of my appt no less, that I had to pay $80 , which at the time I didn't have, seeing as I'm a single mom with a special needs child so I'm on a limited income. And they refused to release my script unless I paid them the $80. Luckily I still had some left. So I came back with the $ and got my script. And all this just came out of nowhere! There were no flyers put up, nothing sent out, nada. So I just figured my insurance wasn't covering the visits anymore either, until I called them. Well it seems that I was right, I have zero co-pays for my visits! I told my insurance co what my Dr had been doing and they said that was illegal. Then they connected me with the state and they too said no that's Medicaid fraud and gave me a # to provider fraud. So yesterday I went to my monthly appt and paid the 80 f-ing dollars and since I either pulled or tore the rotator cuff in my shoulder, I asked if the Dr would increase my dose by half. He said no . I'm like I'm in serious pain and I just paid u $80 ILLEGALLY and u still wanna be a jerk cuz my insurance co I guess threatened them and I didn't pay for like 2mos until my last appt when my Dr said that I had to either pay him the $80 or find another "suboxone dr". I'm like you are a suboxone dr?!? He tried to give some bs excuse that my insurance co wasn't reimbursing him. So I came home and called them again and they said no they have been reimbursing him. But I figured it out. He's not putting down that I'm going there for subutex, he's submitting the claim as anxiety! !! So my question is, has ANYONE else had this problem?? Also should I call the provider fraud on his a**? If I do then chances are he'll go to jail & I won't have my meds anymore. But if I don't then I have to keep giving him money that I just can't afford to give him. And he won't give me pain meds. The whole point of me starting suboxone was cuz I'd been on opiates for years and I wanted something else that would help with pain but not make me a zombie. What should I do??


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PostPosted: Fri Apr 15, 2016 11:46 am 
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I have no idea what to tell u honestly. I don't have insurance, I pay cash so all the rules that insurance has is confusing to me. But one thing I can advise u on is this, if u turn this dr in for fraud and he's really committing fraud, then u will probably need to find a new doctor right? Are u prepared to do that or is there another around ur area with openings? That's the kind of questions u need answers to.

But if I were u, I'd sit down and talk to the dr or the office personnel and tell them exactly what u said here. Sometimes just talking to them and getting their story can at least give u a better understanding of why these things are happening. It could be a simple mistake on someone's part, or they could be really shady and at least you'll know and they'll know ur on to them and not stupid. I wish I could be more help but like I said, when it comes to insurance I'm kinda clueless. There's some really smart ppl here though that can probably give u great advice, hopefully they'll be along shortly.

Good luck. U deserve the best treatment possible and don't stop til u get it! :)

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PostPosted: Fri Apr 15, 2016 12:18 pm 
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I can't pretend I understand everything you just said. I'm not really following all of it and I don't really understand how medicaid works.

What I do know about medicaid is that each state makes up its own rules about prescribing buprenorphine for addiction. You say that your doctor is treating your anxiety with subutex, so he is supposed to be submitting your claims to medicaid, but he isn't doing that? He's charging you instead because he's not submitting your monthly appointments to medicaid. Am I right so far?

I'm trying to work out where the fraud is occurring. Some doctors do not accept medicaid at all and that is their prerogative. Is it possible that he is no longer taking medicaid?

I don't want to sound like a jerk, but are you aware that $80 a month is the cheapest rate I've ever seen for an out of pocket sub doctor? I understand that you have a limited income, but if you went to any sub doctor who didn't accept medicaid, $80 is probably the least you would pay anywhere.

It sounds like your doctor is not communicating with you very well. If you're thinking of reporting your doctor for fraud or threatening him, (which I don't think is advisable at all because he could just drop you), make sure you have already found another source of your medication. Otherwise I think you could be high and dry and detoxing before you are ready.

Amy

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PostPosted: Fri Apr 15, 2016 6:06 pm 
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I'm with you jennjenn, I have no insurance and have to pay cash for everything,. It's my personal belief that there is a lot of insurance fraud everywhere. My mom's an insurance agent and says this is why insurance is so high.

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PostPosted: Sat Apr 16, 2016 4:57 am 
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Hiya,
I too am a little clueless, but I would not rush in to officially report this DR. You have made your insurance company aware so I'm not sure what, if any impact that will have. Like Amy said, it sounds like you would be hard pushed finding anything cheaper. If it is bothering you, follow jenn's advice and talk to the DR.


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