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PostPosted: Tue Jun 08, 2010 1:02 am 
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Beginning of May I needed help with an addiction I have battling. OC's, PK's, Etc...

I found a local doctor who said my first visit would be $135 without insurance, and each visit after would be $80.

I am lucky enough to have insurance, and asked them if that was available to use and they said yes.

Okay, so my first visit was not $135, it turned out they charged my insurance company roughly $600 or so and just made me pay my $10 co-pay. The doctor required that I visit "his pharmacist" down the street to pickup my prescription, when I got there I paid my $10 dollar co-pay for a bottle quantity of 60 Suboxones, however the Dr only approved the pharmacist to give me 14 pills and to get more I would have to make another visit in order to receive another 14 pills.

Seemed very fish... 1 that I could not use my own local pharmacist to pickup my prescription, and 2 that I would be required to visit this doctor weekly to be able to receive more of the medicine... once again at his pharmacist down the road.

My first health insurance statement (Says: This is Not a Bill). That my first visit was $600sh, and that every other visit was about $350 dollars.. they note my savings on the visit dropping the bill to about $150 with my insurance coverages savings and just that I be required to pay my $10 dollar co-pay each Doctors visit.

This doesn't seem right at all, Should I really be paying this much money through my insurance, why would non-insurance individuals pay less if they could only pay in cash? Who can I contact FDA or another agency that could check into this operation/scheme this Doctor has going on with this "friend" pharmacist he has. Shouldn't I be able to demand that I receive my whole prescription that I already paid my co-pay towards than wait until after going to mandatory doctors visits once a week in order to receive more of my pills... I'm sorry this just all seems fishy and scammy to me, I wanted to pickup my prescription from another pharmacy which he disapproved, he also did not allow me to pick up my whole prescription after paying for it in full.... I plan on going in and demanding all my paperwork/records back from him. I also will be demanding he let me pickup the remainder of my prescription in full.


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PostPosted: Tue Jun 08, 2010 2:27 am 
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I would say this situation most definitely smells like fish.

I know there are some doctors who discount the price for office visits for patients who don't have insurance, like those who offer services on a sliding scale. But I don't think that's what's going on here. I say trust your gut on this one.

Also, I think you can call another pharmacy - the one you want to transfer your prescription to - and they will call the pharmacy that currently has your scrip and have it transferred over. Maybe the shady pharmacy will play straight if another pharmacy is the one making the request?

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PostPosted: Tue Jun 08, 2010 7:17 am 
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Here is what I think. This sounds very similar to my first doctor. I don't know if I understand correctly though. For example, when I have surgery, they bill insurance like $4000. Insurance may only allow $1500. I pay my co-pay. So if your doctor is a preferred provider with your insurance company, it isn't uncommon for them to bill at the full rate knowing your insurance will only pay a small amount. Most of the time, the first visit is pretty expensive. My 1st sub doc didn't take insurance and the first appointment was like $350 or something like that.

My first doctor also only gave me a weeks worth of pills via script. Then I think on the next one I got 2 weeks, and then a month's worth. They usually want to follow you closely the first month or so in the event adjustments are needed or there are side effects, etc. I think they can do this also.

The pharmacy thing I am not so sure about. That sounds pretty funky. I don't think your doctor should be able to dictate where you go for your pills. If you want to report it, I think you would have to call the health department first and foremost. BUT...if you decide to do this, you should probably get another sub doc lined up first.

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PostPosted: Tue Jun 08, 2010 6:10 pm 
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Hi jeffryan12 and welcome to the forum. I hope you find as much support in your recovery as I have.

Part of your situation definitely sounds hinky. I agree that you should have your pharmacy call the shady pharmacy to get the script transferred. I'm always amazed at the price doctors charge - knowing they'll only get a portion of it. So that part might be par for the course. If it was me I'd line up another sub doc then report him to the state that licenses him or even the AMA. But I'd start with the state first.

Good luck and keep us posted.

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PostPosted: Wed Jun 09, 2010 12:59 am 
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Thank you so much for your concern and caring words. As of now I am not returning to the doctor I have been seeing, and I have already paid my co-pay towards his pharmacist for a months supply (60) pills. I would like to find a replacement doctor before I tell the current doctor I am leaving him and even before I question him about his prices and odd practice.

Lets say I have Cigna Insurance.. here is what my visit statements look like:

SERVICE DATE/TYPE AMT BILLED DISCOUNT AMT NOT COVERED CVERED COPAY CIG PAID % CO-IN NOTES
5/25/10 PHYSICIAN 125.00 71.18 0 53.82 10.00 43.82 100 0 A
5/25/10 PHYSICIAN 200.00 110.00 0 90.00 0.00 90.00 100 0 A



So why would I be getting charged for 2 different services for 1 visit? 200 and 125? Doesn't make sense, I obviously show up to my appointment, pretty nice office very clean and large, however never any other patients ever there. I actually thought I heard him prescribing Percocet down the hall to another patient once... sounds like a conflict of interest after his spiel about painkillers and why I should be quitting?


After about 6 visits total so far I have been charged the same every time except the first, where it seemed the amounts were double of what I posted above. My insurance company only covers X amount towards my doctors visits a year, and I really feel these meaningless visits are going to hit my yearly cap. I doubt I can get the money back, I just want to stop these bogus appointments just to get my medicine. I would also like to get all my files/documents from him and find another doctor to begin visiting.


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PostPosted: Wed Jun 09, 2010 7:44 am 
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Well, the best way to figure out what your doctor is billing for is to call your insurance company and ask them what code he used and what the code stands for. Then you will know whether or not he provided that service or not. The doctor bills do not look unreasonable to me and I think you will find most doctors doing the same. It really isn't so much about what the doctor bills as it is what the insurance company allows for that service and that is going to be the same no matter where you go. (To the best of my understanding). So you will probably hit the cap equally as quickly through anyone. You may want to consider yourself lucky that you found a doctor that takes insurance because a great majority of them don't and aren't even preferred providers or anything with the insurance companies. I am sure the doc is at least billing for high risk medication monitoring appointments. I don't know what the second bill is for. I do find it interesting that my doctor used to charge cash, $135 per appt. and $175 if there was a UA involved. The $135 is about what your doc is getting after insurance.

I wish you luck in calling around to find someone else. A new doctor will tell you if they need your records or not. Unfortunately, a lot of doctors will insist on "re-inducting" you even if you are already on suboxone. They have a hard time thinking outside the box on occasion. For a very long time, people had few options for doctors and couldn't really switch. I think a lot of the doctors are just now starting to get used to the idea that they may be seeing a whole new set of patients that are already on it and just need to switch.

Again...good luck!

Cherie

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PostPosted: Wed Jun 09, 2010 10:41 am 
Just as an aside: What's up with sub doctors who won't take your insurance and are strictly cash? When I was looking for a Sub doctor, one said to me that he doesn't provide any counseling or oversight, he just writes the prescriptions and it's strictly cash. My husband said, what's the difference between him and a drug dealer?

How many other doctors for other ailments say "I won't go through your insurance, it's strictly cash". Most of them won't take you if you DON'T have insurance!


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PostPosted: Wed Jun 09, 2010 9:21 pm 
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Lilly,

Maybe you should have been in the chat on Monday night as this did come up. I think it has to do with the fact that most sub doctors have smaller practices. MANY of them in WA State are doctors who are borderline unethical or who have been in trouble in the past. Several have had licenses pulled. Drug addicts NEED help and often don't care who they are getting it from. So they will go to you even if you don't take their insurance because it is cheaper than the drugs they were buying anyways. It gives the doctor a practice and they can still make money. I believe once their license has been suspended they often don't qualify as preferred providers with some insurance companies. On the FLIP side of this...I think you have doctors who have a certain set of beliefs with integrity in those beliefs. They don't believe in discriminating against addicts just because they are addicts. They believe in helping people. They believe addiction is truly a disease and not a character defect. They want to help. Some practices flat out don't want to get involved in this. So those doctors have to develop their own practices in order to participate in this type of treatment. You have some very progressive thinkers here.

In both situations, they are smaller practices. Hiring someone to do medical billing is extremely expensive. For a small practice, it is too much for the doctor to do on their own, and it is not enough for a full time person. It is a HUGE hassle. So they just do cash only because it is easier, cheaper, and they really don't have to deal with this when they prescribe suboxone. In addition, insurance companies only allow so much money for a visit. Sub can require longer appointments that insurance doesn't cover. So they lose a lot of money if they accept the insurance.

Those are my thoughts on the issue. It was really nice to complete that thought. Thanks for the opportunity.

Cherie

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PostPosted: Thu Jun 10, 2010 7:02 pm 
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I have often wondered the same thing myself - why some Suboxone doctors don't take insurance. My PCP had a DATA waiver to prescribe Suboxone, and while he took my insurance for everything else, he didn't take it for Suboxone treatment. He didn't take any insurance for Suboxone at all.

He had a very specific protocol for his Sub patients. I just happened to overhear the MA telling someone over the phone one day when I was in the waiting room. It was a 28-day-taper off plan, with several visits per week included and mandator counseling which was not provided by his office. The cost for the 28 days was 3K - which didn't include counseling or the actual cost of the Suboxone.

I was flabbergasted to hear this. He didn't know that I was on Suboxone, but I had been thinking of asking him to take over my prescription at one point. He was a great doc and I really liked him too, so it was too bad.

Me and the MA were friendly (I'd been going there for years) so I asked him why they didn't take insurance. The reasons he gave were:

1. Many insurance companies don't reimburse for addiction treatment or reimburse at a lower amount.
2. It's a billing/paperwork nightmare that he didn't have support staff for.
3. When the insurance companies do reimburse, it takes a long time for the doctor to get paid.
4. The doc felt that Suboxone patients were higher maintainence (not sure what this means really).
5. The 3K up front helped to weed out addicts who were just seeking a scrip to sell.

My Sub doc was great - he took insurance, even DSHS/medicaid, and also offered a sliding scale for uninsured patients. My Sub doc before that was the head of Psychiatry at the VA & was the guy who trained many of the Suboxone doctors in my area. My best friend was also able to find a doc who offered a discount ($50 per visit, usually 1 vist per month) because she was uninsured and also helped her get on the patient assistance program so she got her pills for no cost. We both found our docs through NAABT.org.

I don't know how many unethical Suboxone doctors are out there, but it's an interesting thought. I'd never heard before that many of the Sub docs in WA are docs who have had problems or had their licenses suspended. I live in WA so that is intriguing to me.

If anyone does suspect that their doctor has issues, here is a link explaining how to look up your doctor's license & see if there are suspensions or complaints, which is probably a good idea to do anyway:

http://www.ehow.com/how_4796984_out-doc ... cense.html

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PostPosted: Thu Jun 10, 2010 9:38 pm 
Thanks for the informative replies. I did find out that my sub doc almost lost his license a few years ago for a non sub related malpractice suit. Also he's no longer "in network" with my insurance company, so for some reason he no longer qualifies.
I really hope I live to see the day when addiction is treated with the same respect as any other disease. The doctors should be paid fairly and the patients treated with dignity. Sigh


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PostPosted: Thu Jun 10, 2010 11:03 pm 
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That was some great information. Once again I continue to learn more and more from this site. I was feeling very worried about this new doctor I am goingto see on the 22nd...........seemed shady the whole thing....he even sells subs out of his office and as the person who I talked with about setting up the appointment said "The DR prefere you buy your sub from him" even thoughI told her 3 times I have insurance andit is only $5 for a month's supply...My doc checkedout fineon the website..

I do wonder from the origional poster what stateare they in....because for a minute I thought he may have been talking about my doctor....


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PostPosted: Fri Jun 11, 2010 8:20 am 
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DOQ....There have already been at least 2 that I know of in WA state who have fled to other countries after being caught selling pain pills. The doc I had first had his license suspended for a time and had multiple complaints. Since I work in the insurance industry, I tend to know several of the docs along I5 from Bellingham to Vancouver. I have seen an increase in more reputable doctors prescribing, but unfortunately, there are a LOT of them who have had their licenses pulled and if you call their numbers, they are now disconnected. I also happen to know that where my Mom worked, since all of the doctors except one were skeptical of suboxone, the one who did wish to prescribe still was not allowed to by the clinic. So if they wanted to (reputable doc) they would still have to leave and go to a practice that DID allow it and agree with it or go out on their own. Also, my prior doc told me about several of the other docs who had licenses pulled and he said the DEA is cracking down all the time. There are always sub doctors being relieved of their license because of whatever. I had thought this was quite interesting at the time. It was very hard for me when I first got on sub because I had to find a provider I didn't know or who didn't know me. Back then, there were so few that I did have to use one I knew. I remember thinking specifically....GOD I would never see ANY of these people for healthcare under different circumstances! It is getting better now though.

I am not saying there aren't other reasons for it as well and I am sure there are. I have just seen a lot of this.

Cherie

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PostPosted: Fri Jun 11, 2010 9:28 am 
This is very upsetting, because it's hard enough to be treated fairly as a patient to begin with. I'm thinking of recent posts here where people were denied pain relief or were treated badly after giving birth because of Sub. I thought it was just discrimination against addicts. But if you add to the mix that some Sub docs are shady dealers, that just compounds the problem of gaining respectability.


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PostPosted: Fri Jun 11, 2010 6:11 pm 
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Unfortunately, I think that a lot of doctors look down on doctors who prescribe sub because they are misinformed about it. I think small gains have been made in terms of promoting sub as a valid tool for addiction and not just another methadone. My family doctor still thinks suboxone will cause the need for increasing amounts. He doesn't get it that it isn't like that. Unfortunately, I think sometimes it is one doctor at a time. My current sub doctor was involved in my family doctor's residency. My family doctor has a lot of respect for her. So as she sends him copies of my chart notes, he will ultimately see there is no need for increasing dosages and no lost or stolen scripts and no other problems. Eventually, he may actually ask her about this and maybe he will come to realize this as a legitimate option for addiction outside of cold turkey and 12-step programs that often do not work.

That is kind of off topic here. Also keep in mind, this is just what I have seen in my own state. I have no idea what it is like elsewhere. I would love to hear Dr. Junig provide his take on it.

Cherie

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PostPosted: Fri Jun 11, 2010 7:22 pm 
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Jackcrack -

The most mindbending thing for me about reading your post was that it made me realize that I have NEVER checked to see if a doctor I was getting care from had license suspensions or official complaints or anything. How very trusting of me, indeed.

I think I have just lucked out in terms of my Sub doctors. Since I started off in a clinical study at the VA where I got really great care, and then the doctor at the VA referred me to the doctor I saw after the study. They were both really well-informed and supportive.

We should all do our homework though, when it comes to who we are trusting with our health.

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PostPosted: Sun Jun 13, 2010 2:44 pm 
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corrupt doctor... you can sense it in what he's doing to you already...

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PostPosted: Sun Jun 13, 2010 6:41 pm 
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I had a similar experience with one of my sub docs. I was paying cash for everything, but they took a copy of my insurance card on my initial visit and the doctor told the receptionist that my insurance was not accepted for Suboxone.When I got a statement from my insurance the following month, lo and behold the damn clinic charged my insurance company for my visit. I was beyond pissed. I called the insurance company and asked what the hell was going on. They told me they do cover the office visit but not the urine screen, so basically they were double charging me for my office visit. Luckily I wrote checks for everything and went to the billing department and raised hell. They had to reimburse me for that money. What happened was that the billing department had no idea what they were doing- it was not the doctor's fault. After more investigation I learned that this is not uncommon. Many doctors have no idea that their billing departments are doing these things. Sometimes the receptionists will pocket cash paying patients and mark the paperwork to be paid through insurance. Sounds shady? That is not the half of it.
When I went through outpatient treatment, I was told everything was covered by my insurance, NOT! I started getting bills with five and six charges per day. They were charging me for psychiatrist visits everyday when I only saw the shrink once every three weeks. I called and told my insurance company, again not unusual and they said they would investigate. This was at a big hospital and just imagine how much people are getting screwed.
I do believe for every good doctor there are ten bad ones- just because someone is a physician does not mean they are not human and while they took an oath to care for the sick- life gets in the way of morality. I am sure after a few patients sue a doctor and he loses what he has worked for most of his life, he becomes bitter and begins to become numb.
Most addiction counselors know very little about medication assisted recovery and they don't want to know because are used to doing things a certain way- change makes people nervous. Hell, I make these people nervous because I believe in M.A.T. and I believe that anyone utilizing this tool deserves the best treatment possible. As a student in the field, even my professors and instructors are clueless. It is sad and I hope that somehow I can make a small difference. I was stopped from working with a treatment program because of my recovery choices. It is not fair and it has infuriated me as a professional, but it is reality and I have to do my best to handle these situations in the most professional manner.

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PostPosted: Mon Jun 14, 2010 9:04 am 
Shelwoy, as bad as your insurance story is, I find your experience as a student of addiction treatment on sub even more disturbing. If you feel comfortable sharing this with us, what kind of treatment program were you working at and how/why did they stop you from working there?


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PostPosted: Wed Jun 16, 2010 11:22 am 
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Lilly wrote:
Shelwoy, as bad as your insurance story is, I find your experience as a student of addiction treatment on sub even more disturbing. If you feel comfortable sharing this with us, what kind of treatment program were you working at and how/why did they stop you from working there?


agreed on your point Shelwoy...

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PostPosted: Wed Jun 16, 2010 12:23 pm 
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This is a really interesting thread. I hope everyone is doing ok with their various situations. My insurance situation with my doctor has been really confusing to me too...first there were questions about whether she took my insurance or not....and then, how much the appointments cost seems to be in constant negotiation..the last time I talked to the billing person at my doctor's office I became genuinely concerned for her mental health--dealing with the insurance companies must be so hard for her and I know that she really works hard to help the patients with confusing insurance issues. Reading about all these unethical doctors makes me feel even more strongly that it is important that I be honest with my doctor about my experience on suboxone, because my doctor is a good psychiatrist who works with addicts and really wants to help but seems to not know as much about suboxone as she ought. Suboxone is a complicated medicine, I think, and a relatively new medication for addiction, at least in the U.S., so it's not surprising that it's misunderstood by a lot of people. Shelwoy, thank you for your passion about medical-assisted addiction treatment. One thing I also just want to mention on this thread is that mental illnesses too are often misunderstood and treated unfairly by insurance companies. For instance, on my bills my appointments are listed as "cognitive therapy" which is really not true at all--I dont' get to see my psychiatrist often or for long enough to have actual talk therapy--we are really not able, due to time constraints, to talk about much other than medication issues--I really like my psychiatrist and I would LOVE to be in therapy with her, but there is not way I could afford it.


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