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PostPosted: Thu Nov 04, 2010 10:49 am 
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Hey all...it has been awhile since I have been around, I have been beyond busy..... I'm so pissed off right now at work, as I just found out our new insurance will not cover Suboxone. I have one pill left at this point and I don't know what to do. My doctor just called me up advising they don't cover the medication. I was given an address to appeal the denial.. The insurance company is Coventry....

I'm 37 years old and know this disease kills.......Im just stunned that my insurance has denied me medication that is keeping me stable. ARGH, I'm burning up at this point. I'm closing in on one year from using my drug of choice and I owe most of it to this incredible medication.

Not sure what to do at this point...I know I haven't been around awhile but I'm coming for support and any help anybody may suggest.

Thanks,

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PostPosted: Thu Nov 04, 2010 11:31 am 
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Aks your doc to put you on Bupreorfin and they might just process as a pain pill and will or should pay for it talk to the doc tell him the situation and maby he will help ypu out

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PostPosted: Thu Nov 04, 2010 11:48 am 
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Hi Super! It's so great to hear from you again. I'm only sorry for the reason that brought you back. That would be shocking...I know I would freak the fuck out if I lost my insurance coverage for suboxone. Rsaylor had a good idea - check to see if they cover Buprenorphine, rather than Suboxone. Maybe they cover subutex? Or even the generic? Regardless, if it were me I would definitely appeal their denial.

Doesn't it just piss you off how the insurance companies never seem to deny anyone's coverage of pain pills, but they have no qualms denying a life-saving treatment? That's utter bullshit, if you ask me.

Anyhoo, I hope you get it straightened out. Hang in there my friend, and please - let us know how it goes. Again, it's nice to "see" you again.

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PostPosted: Thu Nov 04, 2010 12:21 pm 
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rsaylor8326 & hatmaker510 - This is a Suboxone program so they can only prescribe me Suboxone.....I asked him to prescribe me the generic when I lost insurance and he couldn't as the type of program I'm in. Can a Psychologist prescribe medication for pain? I figured I would have to see my family physician for that or a pain specialist. If they cover Buprenorphine I may be able to discuss the situation with my family physician and see what they can do...

I told my wife I may just stop Suboxone. Her answer was "Stopping Suboxone is not an option".

The most interesting part about this I just called the pharmacy. They told me I owe $64 for the script... I used to pay $15 with my old insurance company and I was paying $300 cash when I had no insurance. Why $64? If Suboxone was denied then why am I paying $64?? The doctor told me the plan we are on they don't cover Suboxone at all... With that said my wife is going to the pharmacy now to grab the script for $64 and we will deal with any issues later.


hat - I really miss browsing the site and posting and it's nothing personal to anyone here.... I have been so busy with work, kids, the move still it has been crazy.....even side work has kept me very busy. I think about the site often but I find myself sitting on the couch around 10:30PM and talking with my wife for a few and then passing out.... hopefully things will slow down and I can get back into action here....


Anyways, thanks for posting so quickly...

SuperBuper


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PostPosted: Thu Nov 04, 2010 12:33 pm 
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Oh man, that really does suck. Sounds like your sub doc isn't very willing to work with you either. I would talk to the family doctor, maybe he will prescribe generic subutex for pain for you. Any doctor can prescribe it for off label use without having to have the DATA 2000 waiver. It's just a matter of if s/he is willing (and assuming your insurance covers the generic bupe). I would go ahead and file that appeal just to cover that base though.

And Super - don't worry about being so busy that you can't make it here as often as you used to. It's just good to see you again. Being that busy and falling right off to sleep is kind of nice though, isn't it? Take care, my friend.

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 Post subject: Insurance Issues
PostPosted: Fri Nov 05, 2010 4:10 pm 
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Hat - well here's the deal, I called the insurance company myself. The woman I spoke to said they never denied anything. She then stated that's why we just approved your first script. She mentioned my doctor now needs to fill out some type of pre authorization form for future scripts.

I then called back my doctor and spoke to the receptionist that works there. The doctors receptionist told me she called the insurance company and they told her not to even bother with the pre-authorization as it will be denied anyways. She told her to have me file the appeal.

I then called the insurance company back and spoke to a different person. They told me how can you appeal something if it was never denied. They mentioned again the doctor must fill out the pre-authorization form blah, blah, blah. the insurance company faxed the document over.

I called the doctor's office again. She filled out the form and faxed it over.. It was then denied because I must be in some type of therapy along with the medication. The doctor even checked off a box that I was seeing him for therapy. The receptionist called the insurance company and gave them an ear full about denying a patient medication that is detrimental to their life.

That's where I'm at.... My family is paying $800+ a month for group insurance and I'm being denied a medication that has saved my life....


...........appeal in process!

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PostPosted: Fri Nov 05, 2010 11:11 pm 
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This is a "damn insurance companies" thread alright. Man, I'm so sorry to hear about you having such a hassle. You know, I had an experience with my insurance company where they were definitely telling me the opposite of what they were telling my provider. It was really weird. It really makes you wonder what the hell is going on with the policies those companies follow. Anyway, you now have your script for the next month filled, right? and the appeal is in process, that's good, and i sure hope it works. It sounds like your doctor's office IS on your side too, that is good too. It is tolally discriminatory that an insurance company would try to deny coverage of suboxone. It really seems like insurance companies follow the rule of "Deny, Delay, Don't Pay." Totally sucks. I know this is a stressful situation for you, but hang in there and hopefully all will be well in the end. I think it's a good decision to stay on your medication rather than letting it lapse because of financial pressure. People shouldnt' have to stop treatment for illnesses becasue they can't afford it. But of course it happens all the time. Good luck, and lkeep us updated, ok?


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PostPosted: Sun Nov 07, 2010 10:32 am 
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Auto - Yah, I have my script filled for the month so I'm good for a bit. This really was the last thing I would expect to happen. I'm going to write the letter today and fax the letter to the insurance company tomorrow. My doctor advised me they would write a letter too but they charge $75....I'm going to use that as my last resource. If insurance doesn't work out with Suboxone, I may try other options like Hat mentioned. I do have an MRI that shows I have back issues. So I may be able to find a doctor to prescribe me Buprenorphine for my pain. Well for now I'm just going to live in the moment. This is just another obstacle that I must overcome.

Thanks all for your support......

SuperBuper


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 Post subject: Letter
PostPosted: Mon Nov 08, 2010 4:26 pm 
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Well.....I wrote most of the letter and I just keep reading it over and over....hoping the letter is good enough... I kind of told my story within a few paragraphs going as far as telling them I ended up snorting oxycodone everyday just to get high. I even advised that Suboxone helps with my back injury and helps take the edge off with the pain.

I guess we will see how it goes, I really want to work aggressive at this as 30 days will go very fast. I'm even thinking of tapering back my dose a bit. This really sucks....


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PostPosted: Mon Nov 08, 2010 4:55 pm 
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Hey Super,

So your letter is basically your appeal? I am really hoping for your sake that they will reverse their denial and cover it for you. You might have a good idea about tapering your dose a bit. One month DOES go by very fast. Forgive me for not remembering, but what dose are you on? If it were me I might see if I could drop my dose and stay above the ceiling just to extend what pills I would have until the decision is reached. It might be worth a try. Good luck and please do keep us posted.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Mon Nov 08, 2010 5:28 pm 
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OH, man, this kind of thing really scares the crap out of me. It seems like my job switches insurers just about every year. we play this back and forth game of Blue Cross, then Harvard Pilgrim, then Blue Cross, then Harvard Pilgrim, back and forth, over and over......and while I'm pretty sure that Blue Cross would cover it (I am currently on Harvard Pilgrim) this kind of thing really bugs me.

Super, I'm really sorry you have to deal with this crap. Here's what I know about insurance companies and expensive medications: I was once denied for AmbienCR, by Blue Cross. I contacted the insurance company and they told me I needed a letter from my doctor that verified it was a medical necessity. My doctor provided the letter, and that did the trick.

I don't know if this can work with subxone, but it seems to me if a generally superfluous medication like a sleeping pill can be deemed "medically necessary" then suboxone surely can too.

Please keep us updated on your situation


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 Post subject: Appeal Process
PostPosted: Mon Nov 08, 2010 11:07 pm 
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Junkie what you said really was an eye opener... Medically Necessary.. My doctor is actually out of town and I'm dealing with the receptionist. When I mentioned earlier my doctor spoke with me I was only speaking with the receptionist. I have to be careful with they way I word things... I was simply thinking of my doctor’s office in generally.. My doctor is actually out of town until the 15th....I think I may wait to speak with him directly to see what he says, I know he agrees I should be on this medication long term..... The receptionist is the one that advised I should write a letter first but she also mentioned the doctor could write a letter too for $75... I'm thinking I need to put my letter on hold and have the doctor write a letter to state it's medically necessary for me to have this medication.

Hat - I generally take 8MG a day of Suboxone.....I may drop down to 4MG a day over the next week. My wife is not happy with my decision to drop down a bit but she doesn't understand that 4mg should do me just right. I was as low as 2mg a day when I first went to an outpatient detox... When I was at 4MG I was pretty stable... 2mg was pushing it for me.... My new doctor that is providing long term treatment wanted me at 8mg minimum for maintenance.

Anyways, thanks all again for your support... This site is great!

SuperBuper


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PostPosted: Tue Nov 09, 2010 11:50 am 
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Hey all.....well I went ahead and paid the doctor's office $75 to send out a letter of medical necessity to my insurance company....The letter has already been sent to the insurance company. Hopefully all will go well...

Is this normal to pay a doctor for such a letter? I understand it may take time to write the letter...or maybe they have a template....the receptionist literally called me back five minutes later to tell me the letter has been sent. Anyways, I would spend more money on dope so to stay clean it's hard to put a number on it.

SuperBuper


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PostPosted: Tue Nov 09, 2010 12:23 pm 
I'm not sure if the doctor charging for the letter is normal protocol, but I have to say I'm glad you didn't send the letter you said you had written. I mean, once you put stuff like that in writing (snorting oxy) you just never know who's going to end up seeing it or if it's going to come back to bite you later. Better to do what you did and just stick to the medical necessity facts and leave out the gory details.
I hope it works out for you. I'm still dealing with my insurance company, who has paid my doctor a total of about $300 total since my induction last October. I've also been paying a little each month, but the doctor would be well within his rights to stop seeing me.
The health insurance industry is a complete disaster, and I don't understand why people aren't up in arms about FOR PROFIT companies controlling our healthcare.


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PostPosted: Tue Nov 09, 2010 5:52 pm 
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I used to live in the metro Detroit area and doctors there would write practically any letter/documentation at no charge. Last year we move about 75 miles away and ALL the doctors here charge an arm and leg for any documentation from them.

Lilly, I agree with you about our healthcare industry being for-profit. I'm one of those people who are hopeful that the recent health care reform legislation will reduce both the amount of power that insurance companies have and the abuses they heap on their customers. Unfortunately, I don't think the legislation went far enough. But that's a different topic altogether.

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-I'm only responsible for what I say, not for what you understand.


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 Post subject: It's a winner!
PostPosted: Tue Nov 09, 2010 10:34 pm 
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The insurance company reviewed the letter of Medical Necessity and approved the next three months for Suboxone. That's a nice relief. I see my doctor again at the end of December so I will be having a talk with him about the future. Is this going to be a quarterly event? Paying him $75 for another letter etc...??? Or what happens after three months??? For now I know I'm safe for a bit and it's a nice relief especially after dealing with losing my house and settling into our new place.

Lilly - I laughed when I read your quote about the "Gory Stuff". The receptionist told me to write a detailed letter about my addiction.....I really didn't feel comfortable with it at all but I was so aggravated I wanted them to know this is serious shit. After reading Hats & Junkie's comment I stopped and thought about what I was doing. I too am glad I never sent my letter....Not sure why the receptionist never mentioned a letter of Medical Necessity...I remember those back when I worked as an EMT.....Anyways, it seems like you have yourself a nice doctor. I pay $90 a visit as they don't take my new insurance. I even asked if I could pay the $75 for the letter during my next routine visit... Receptionist told me no letter without no money.....I was a little angry over that but I always think to myself I would have blown $75 in dope in a split second without a thought. So I just moved on....

Once again this site has helped me make a rational decision and I'm grateful today. I just want to thank everyone that has supported me through these times. It's so nice to have this type of support from people that understand what I'm going through. This was a tough year for me all around.

I'll keep you all posted on this matter…
SuperBuper


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PostPosted: Tue Nov 09, 2010 10:51 pm 
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I'm SO glad they approved it for you! Let's hope they continue to do so. I'm not sure how they determine how long the approval is for. It might depend on exactly what the doctor said in the letter. Did you get a copy of the letter that went to the insurance company?

I have psoriasis and I take Humira, a very, VERY expensive TNF/immune blocker (between $2-3K/month! :shock: ). I'd been filling it without incident for almost a year then one day I drop off the script to be filled and BOOM - all of a sudden they tell me that it needs prior authorization/pre-approval. My doctor took care of it right away (thankfully) and both the doctor's office and the pharmacy told me I now have lifetime approval. Maybe it's because it's an incurable condition? But so is opiate addiction, right? Who the hell knows how those damn companies make their financial decisions.

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-I'm only responsible for what I say, not for what you understand.


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 Post subject: Sure Happy
PostPosted: Thu Nov 11, 2010 9:07 pm 
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Hey Hat thanks for your reply... Yah, I have a copy of the letter. The letter was about four lines basically stating why it was medically necessary for me to be treated with Suboxone. The insurance company said after the three months are up they want a plan of treatment... Not sure what that means, I have to call the doctor's office tomorrow to get a better understanding of that. I'm looking forward to speaking to the doctor next month too. He is a firm believer of long term treatment.

Wow, I'm glad you don't have to worry about Humira not being covered....I would think being denied for either one with doctors authorization/medical necessity would open up a possible liability issue if something ever happened such as death or overdose from the condition... I don't know much about this stuff, I'd be interested to know.

Anyways, I flipped out a bit as I usually do because Suboxone to me is a barrier. Suboxone allows me to live in society without a tremendous amount of therapy if any. As I always say I'm grateful I found this life saving medication.

SuperBuper


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 Post subject: More Issues
PostPosted: Wed Nov 17, 2010 9:35 pm 
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Well, I wasn't sure where to post this message, as I have this thread here and one in "Opiates and Chronic Pain". I'm dealing with my back flaring up and my Sub doctor bumped up my Suboxone dose to 16mg from 8mg a day. Guess what happened... I turned in my new script and my insurance denied the script once again. This is interesting though as they just recently approved me for three months..

Not sure how to explain this but I think I know where the problem is... I just saw my Sub doctor back on November 2nd....I believe :roll: . He wrote me my normal script (8mg a day - with a refill the following month) and that's when I had the first issue with my new insurance company. I went back to him on the 15th of November and he bumped up my dose to 16mg a day to assist with my stressful situation :roll: . He didn't just write me a script for the additional pills he wrote me a brand new script enough for four weeks. The insurance company didn't like this I guess. The doctor even rescheduled my next appointment from two months to four weeks since I'm on a new dose.

So now, I have been taking more Suboxone to relieve the pain but I'm eventually going to run short on pills if they don't approve this shortly. Anyways, I just wanted to update the thread as I'm again in limbo with the insurance company.

Here we go again....

SuperBuper


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PostPosted: Thu Nov 18, 2010 9:21 am 
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Super - Sometimes you just have to point out to the pharmacy that your dose was increased. That's happened to me before. They look at the script and go to put it thru the insurance company only to have it denied because it's too early. They don't pay attention to a change in dose. Just point it out to them. You never know, maybe that will do the trick. Let us know what happens.

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-I'm only responsible for what I say, not for what you understand.


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