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PostPosted: Tue Aug 16, 2016 7:41 pm 
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I have been on buprenorphine for 5 years now. During this time I have seen the same doctor, have not relapsed, and have always had a negative drug screen. I initially was started on Suboxone and after a few months, I was switched to buprenorphine because I was experiencing adverse side effects. Swelling in my extremities and horrible migraines. I also didn't have insurance at the time and the buprenorphine was significantly cheaper. After I got insurance, a prior authorization was required and the doctors office always completed it so my meds would be covered. Keep in mind, the doctors office is the physician and his wife/office manager.

Recently my insurance company required another PA and I had all the forms faxed to the Dr's office. A month passes and it still hadn't been received by my insurance company. At my appointment, I ask the Dr's wife about this and she tells me they don't do authorizations on subutex/buprenorphine, only on Suboxone and subsolv. I tell her that she has done my PAs for the past 5 years why is it an issue now. She says it must have been overlooked and they don't do PAs for subutex. I get in with the Dr and he says the same thing. I explain again that it has never been an issue. He looks though my chart and says ok we'll do it. This was last Tuesday. I call the Dr's wife today to ask about it, and she says they decided not to do it after all. Same stupid explanation that doesn't make any sense. She said my chart said I was put on subutex because I didn't have insurance and my chart said nothing about side effects. I told her that I want an explanation as to why all of a sudden she won't fill out a simple form so that my insurance company will pay for the medicine. She says I'm obviously not happy with their services and maybe I need to finda new doctor. Why would she force me to pay full price for a medicine that I can get for $8 a month? Yes i understand that people who pay cash prices for name brand suboxone have to pay a lot more, but $200 a month vs $8 a month is a big difference.

Like I said I have not relapsed in five years. I comply fully with their program and pay $120 a month because they do not accept insurance. This woman has been very ugly and rude to me many times over the last five years and I do not say anything because she is the doctors wife and I know I have no recourse there. You don't treat your patients/CUSTOMERS like that. You do what you can to help them. Especially patients like myself who have proven to be reliable and trustworthy. I feel like I am being accused of some wrong doing and punished and I don't know why. They know we are addicted to this medication and need it so they treat us like shit. Sorry for the long post I'm just upset about being treated like crap by someone I pay my hard earned money to.


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PostPosted: Tue Aug 16, 2016 8:29 pm 
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To answer your question, Yes, I would pay for it out of pocket if need be. I think that it is hard to find doctors that will RX straight buprenorphine. I'm sure that doing PA are a pain for Drs offices and a service that is not reimbursed. Maybe if you were able to look at it from the other side it would help. Thank the office staff for completing PA in the past and maybe offer reimbursement for future services. Common wisdom is that straight buprenorphine has more potential for abuse. When I first started suboxone, I was paying over $500 a month for health insurance (2005) and I paid $175 for Dr appt 5 minute appt. $25 for drug test and $300 a month for brand name Suboxone. I did this for 15 months until Suboxone went on my insurance formulary. Do whatever you need to do to stay off opiates.
Best of luck.


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PostPosted: Tue Aug 16, 2016 9:30 pm 
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Hi, I do think that I would look for a new Doctor! This Doctor knows the importance of this medication and from what you describe, you have been a model patient! Good luck! Let us know how it goes!


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PostPosted: Tue Aug 16, 2016 10:16 pm 
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I'll provide an answer, but my perspective is from the doctor side. Hopefully my answer will provide some insight into the doc's thinking. After I post, I'll leave this thread alone for others to respond to.

My office is similar to what you describe, and my wife is the office manager. I see her as innocent in the issues that come up with patients. She is very nice-- nicer than me--- so she rarely has issues with patients. But she is sometimes put in positions where she has to do what I say, from a medical or business perspective. I may say, for example, that I will not approve buprenorphine. In those situations she has to face the patient's anger, even though she had no role in the decision. In those cases I become very angry if patients take anger out on HER, because it wasn't her call. Maybe I even feel a bit guilty for exposing her to this whole world of addiction, where patients sometimes aren't entirely truthful. We both try to see the best in people, but people are often in dire straits, leading them to take out anger on her, or on me.

My charges for stable patients are a bit less than what you pay. But now and then I'm struck by the bargain patients get when treated for addiction with buprenorphine. I had a mole removed a month ago, from my back-- a procedure that took about 15 minutes. I got my bill last week, and it was over $2000. I have a high dedutible, $8000 per month, but my insurance still costs over $10,000 per year for two people, so insurance paid nothing. The itemized bill included specimen handling fee ($50), professional microscope fee ($300), technical microscope fee ($400), removal of mole ($300), and wound closure ($400). The rest of the 2 grand was for the pathologist, for a 'room fee', and for other miscellaneous charges.

So I paid $400 for a 'technical microscope fee', but insurance companies will only pay me $70 for a patient's appointment. That's why many docs in this business do not accept insurance; the payments by insurers are very, very low compared to other medical charges. I assume the reason is that they do not appreciate addiction treatment, but it all comes down to supply and demand. And addiction patients are too sick to 'demand' better coverage.

About the PA-- many, many docs are not comfortable prescribing buprenorphine. Some states even ban the drug, or at least one does that I know of. Docs fear that their peers will criticise them, and they will be investigated and disciplined. That fear is not entirely unrealistic.

I no longer do PA's for buprenorphine with medicaid, because they NEVER get covered. Some insurers will approve it, and some never will. You had it covered before, so your insurance may be likely to cover it again-- but some insurers have stopped covering it. Your doc may have gone to a meeting, where other docs talked about all of the diversion of plain buprenorphine. I've been to meetings where that was a topic of discussion. I argue with that opinion, as I think the fear of diversion is overblown in stable patients. But many docs say things like 'plain buprenorphine is the same as heroin'-- a very stupid thing to say, but something I've heard more than once.

I have had one patient out of hundreds who had an actual allergy to naloxone, complete with hives after trying it on each of three occasions. I think that a true intolerance to naloxone should call for use of buprenorphine, and I will do a lot of work in those cases to get it covered, including PA's and then appeal letters. But sometimes a patient will push and push and push, even after a PA is denied. I have had situations where I literally spent hours on letters and phone calls, and buprenorphine is not approved-- and patients continue to complain. I eventually have enough in those situations, and tell patients that I'm done with appeals, and it's time to accept what's covered, or find a new doc.

I got pulled away from this post for a few minutes to watch part of 'Bachelor in Paradise', a truly bizarre tv show... so this all probably sounds a bit disjointed. I'm going to hit the 'submit' button and move on...


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PostPosted: Wed Aug 17, 2016 5:13 pm 
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WE need a Bachelor in Paradise thread!! So we can Watch and Discuss. It is such a Trashy show but yet pulls me in everytime.
Sorry for hijacking the thread but when i read Bachelor in Paradise, I had to chime in. ahha!


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