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PostPosted: Mon Apr 18, 2011 2:50 pm 
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Someone has to step up, whether it be a doctor or a famous person who has been helped by suboxone, to stop doctors from taking advantage of addicts and abusing the suboxone program and get insurance companies to fairly reimburse doctors who agree to treat opiate wd.

Doctors are charging hundreds, and sometimes thousands, as "initiation fees" or for BS drug testing that is unnecessary and very expensive for the patient. I will not accept the argument: Would you rather be addicted or pay the fees? That's an unfair way to approach this epidemic abuse of this program.

In the office today waiting for my appointment I overheard this man who was also in the office trying to get on the program. He has no insurance and it was pretty obvious he didn't have a ton of money because I heard him say he lives in a trailer. He's not loaded. The administrative nurse tells him there is a $400 initiation fee that he must pay before the doctor will even talk to him. He had his mother pay that bill with a credit card. Then the woman came back and said "The doctor is going to need another $350 for an assessment fee."

I was just blown away. This is wrong.

My own situation is troublesome. My doctor keeps giving me drug tests, which I realize is part of the program. But he also gives me this $50 suboxone drug test and I "have to pay this out of pocket because they won't send it to the insurance billing." What does that mean? It means it's a BS test that does not need to be administered and they pocket the $50. Not only is this troublesome, but when I get drug tested, I get tested for every drug under the sun---some I have never even heard of and would never do!!! The Drug test costs $650 and my insurance covers 80 to 60 percent of the test. It's RIDICULOUS!!!!

I know doctors are charging these unethical "initiation fees" and "assessment fees" that the insurance companies will not pay. I look at it this way: If my insurance company is refusing to pay any of the charge, then the charge is unnecessary and the doctor is trying to take my money.

I am very upset over this and angry. I think there needs to be more rules on these doctors and better working relationships with the insurance companies because something IS NOT RIGHT! If I have to take regular drug tests and regular visits and counseling and all of this recovery stuff, then these doctors should have to follow some basic rules. How can they look at themselves in the mirror when they are charging these outrageous fees?

Has a doctor ever charged someone $400 for an initiation fee to get help with diabetes?
Has a doctor ever charged $800 as an initiation fee to get treated for cancer?

Who has our backs? Who is going to advocate for us? THIS IS WRONG!!!!

No doctor should be treating this program any differently than any other life-saving treatment. All of the money I would have saved from not buying drugs are going to these doctors!!!!! That's WRONG!!

I shouldn't ever have to think: Gee, is it better to be all fucked up on drugs than getting this help because of the cost? I should never have to calculate which is cheaper, drugs or treatment?

Clean your acts up, doctors. I am not kidding. I will not let this continue.


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 Post subject: Yikes, that sucks
PostPosted: Mon Apr 18, 2011 4:19 pm 
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That absolutely sucks. I'm so sorry. I do think some docs are milking this for all it's worth. I mean, I had a friend (whose wife is a doc) and they've always had this stance of "we are so compassionate about pain and addiction" thing. I totally bought it. I mean, they are nice people. She told me at one point when we were talking about what school she was going to move her kids to, that her husband was 'putting everyone on this medication called Suboxone' and Suboxone was paying for the pricey tuition and their new house in the expensive area of town. She said their practice had boomed since he starting doing Suboxone as well as pain management. She had no clue I was on Sub myself. It's such an easy way to make money. I have another friend whose husband's a doc (not far out of residency) and he said he's had friends from med school who have gone into prescribing Sub simply because it pretty much ensures a good income, which is very tempting, especially in this economy. I do think there will be a shake up and restructuring of things. There's something about this whole thing that doesn't smell quite right, and it only becomes clearer and clearer as time goes on.

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 Post subject: unethical
PostPosted: Mon Apr 18, 2011 4:42 pm 
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It doesn't take a rocket scientist to figure out that more than not, doctors who can prescribe this drug are milking the system and the patients.

I cannot stand my doctor. He's forgetful, not reliable, always cancels my appointments and won't stop drug testing me every month. He kicked me out one time because he accidentally thought I was taking 8 mg when I was taking 12 mg, so when I called for a refill they accused me of misusing it or whatever. Ever since then, he does this separate $50 drug test for suboxone. Yes, he is testing me to make sure I take suboxone. What a dumb ass test. WHat's interesting is, I did not pee in two different cups. Just one. So, does he test my pee from that cup and then close it and send it off to the lab? Something's real fishy.

Today, he tested me for the $50 sub test but I wasn't asked to pay the $50. At 1 pm the office called me back all mad that I was supposed to pay the $50. I told her to send it to my insurance and she says "We don't file this with the insurance. The patient has to pay it."

That right there makes NO sense. I pay for the insurance coverage and I work a lot of hours. If there is a problem with how insurance companies are reimbursing the doctors, that's not my fault. But any doctor who is doing a drug test specifically for suboxone only is being an unethical piece of garbage.

I don't even want to be on this anymore. I am sick of this guy. I am sick of this whole process. I feel like I've been clean at a huge cost---like I stopped paying one drug dealer so I could pay another disguised as a "doctor."

You call around and all of the other doctors want $1000 up front before they even let you in the door and some won't even take insurance. It's all out of pocket

I think I am going to write a letter to the state board or something. This is out of control.


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PostPosted: Mon Apr 18, 2011 6:03 pm 
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My psychiatrist scripts me my Suboxone, he writes psychotherapy on the invoice and my insurance Co. pays half.. He sees me for 15 mins and charges me $75 bucks and I pay $37.50 a month... I have never taken a drug test of any kind... LOOK AROUND for someone else, this Dr is a shister, there is no laws broken here, Oh, and I'm sure he pays taxes on the cash he gets, there are several Drs like yours around here also, they were honest and told me all the $ I would need on the phone before I got to their office and I bailed on them, Good Luck, Mike


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PostPosted: Mon Apr 18, 2011 6:37 pm 
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I'm sorry to hear how frustrating your treatment has been. I can sense how upset you are. I don't at all want to make that worse. However, there really is more to all of this than you are seeing.

To start with, I am wondering if you are under treatment for any other chronic illness or have dealt with other doctors outside of a one time visit for a virus/infection or something. I ask, because what you are describing could very well be applied to all sorts of other areas of healthcare. What is happening with you is really not different with other areas. You ask about diabetes and if they have to pay these fees. Unfortunately the answer is yes.

While I most certainly agree that there are some bad docs out there that are milking the system, I also see all of this from the other side. I'm not a physician but I have been involved in healthcare much of my life and have many friends in healthcare. One of my doc friends is so fed up with the insurance crap that he now is a corporate pilot and just moonlights part-time as an ER doc. He says that he no longer treats patients - the insurance companies do. Another friend gave up his practice and became a teacher at a medical school. He was a surgeon and simply could not make ends meet. The crap that goes on with insurance is not in any way, shape, or form tied only to Suboxone. Plain and simple, $400 does not buy much at all in today's healthcare arena.

As for the drug testing, it is very, very, very common - including testing for Sub. Why on earth would they test for Suboxone you ask? Simple, there are people out there who fake needing it, get it prescribed and sell it for $25/tab - or whatever the going price is. Therefore, many docs now test to make sure it is in the patient's system. The same thing happens to pain patients. Chronic pain patients who are on daily opiates are very often tested to make sure they are taking their medication. Again, the only reason is diversion. There are those who will try to get pain meds just to sell. It is not a scam or unethical to test you for Sub. I'm not sure what is going on with not submitting it to insurance. That does not mean that you cannot submit it to your insurance on your own. In my case, my doc tests me as well. However, he does not charge for it. It is simply included in his overall fee. If I fail, it is then sent to a lab and that is billed. I have to pay for my Sub out of pocket and then submit it on my own to my insurance for reimbursement. You can submit claims on your own to your insurance.

I don't expect this to make you feel any better. I just want to point out to you and everyone else, that this is not specific only to Sub. Your very valid complaints can also be applied to ____________ (fill in the blank) medical treatment. $400 for an initial induction fee is also not out of the norm. Again, the way healthcare works is the doc is expected to see about six patients an hour. He often can bill about $125-150 for those ten minutes with patient. If a Sub induction takes an hour - well you do the math. Even at $400 he is making less than if he saw six patients. Many docs are paying $100,000 + for malpractice insurance. Where/who do you think that comes from?

I don't like it anymore than the next person does. This is healthcare in America. Being a doctor today is not anywhere near what being a doctor was twenty years ago. With hundreds of thousands in medical school loans to pay back, huge insurance costs, and insurance reimbursement getting worse and worse, it is no longer the "cash cow" that it used to be. Just please don't think it is only related or happens with Sub treatment. It happens with pretty much everything.


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 Post subject: wrong
PostPosted: Mon Apr 18, 2011 8:33 pm 
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Sorry, I stopped reading your reply when you claim that patients do have to pay initiation fees for other diseases. You are wrong and I'm not reading what else you wrote because I don't think you are credible for information. Sorry to sound so blunt, but I have diabetes and I get my meds and see my doctor and my insurance covers almost all of it. No initiation fee. No BS.

My best friend had cancer and she didn't have to pay any initiation fees or other fees that the office won't even send to the insurance for reimbursement.

It is obvious that I have a firm belief about this because I see it happening to me and others every week, and it is also obvious that I am passionate about this situation changing for everyone. This isn't anger; I am not going to have someone reply with false information to fuzzy the truth even more. I admit, that does piss me off.

The fact of the matter is, if I go to a doctor and they find that I have diabetes, there isn't a $400 initiation fee, and to say otherwise is just protecting suboxone doctors who do this. Same with cancer. Same with any disease that's not related to drugs or alcohol.

You're not helping. If you don't think doctors are abusing this, then get your head out of the sand. Stories of doctor abuse plaster this forum. It's disgusting that nothing has been done yet.

And the argument "Get another doctor" pisses me off, too because I have tried and when all who I have reached out to have these fees, I refuse to talk anymore. This doctor's office said they did not have initiation fees. Now, I find out they did. The number of sketchy BS from this office is unbelievable.

I have called every office that is listed within a 30 mile radius and they either charge initiation fees, don't have room or won't take insurance. I've posted on her for doctors and I haven't received anything. Don't assume that I am just content with my situation, please, because I am not.

I honestly regret starting this program.



donh wrote:
I'm sorry to hear how frustrating your treatment has been. I can sense how upset you are. I don't at all want to make that worse. However, there really is more to all of this than you are seeing.

To start with, I am wondering if you are under treatment for any other chronic illness or have dealt with other doctors outside of a one time visit for a virus/infection or something. I ask, because what you are describing could very well be applied to all sorts of other areas of healthcare. What is happening with you is really not different with other areas. You ask about diabetes and if they have to pay these fees. Unfortunately the answer is yes.

While I most certainly agree that there are some bad docs out there that are milking the system, I also see all of this from the other side. I'm not a physician but I have been involved in healthcare much of my life and have many friends in healthcare. One of my doc friends is so fed up with the insurance crap that he now is a corporate pilot and just moonlights part-time as an ER doc. He says that he no longer treats patients - the insurance companies do. Another friend gave up his practice and became a teacher at a medical school. He was a surgeon and simply could not make ends meet. The crap that goes on with insurance is not in any way, shape, or form tied only to Suboxone. Plain and simple, $400 does not buy much at all in today's healthcare arena.

As for the drug testing, it is very, very, very common - including testing for Sub. Why on earth would they test for Suboxone you ask? Simple, there are people out there who fake needing it, get it prescribed and sell it for $25/tab - or whatever the going price is. Therefore, many docs now test to make sure it is in the patient's system. The same thing happens to pain patients. Chronic pain patients who are on daily opiates are very often tested to make sure they are taking their medication. Again, the only reason is diversion. There are those who will try to get pain meds just to sell. It is not a scam or unethical to test you for Sub. I'm not sure what is going on with not submitting it to insurance. That does not mean that you cannot submit it to your insurance on your own. In my case, my doc tests me as well. However, he does not charge for it. It is simply included in his overall fee. If I fail, it is then sent to a lab and that is billed. I have to pay for my Sub out of pocket and then submit it on my own to my insurance for reimbursement. You can submit claims on your own to your insurance.

I don't expect this to make you feel any better. I just want to point out to you and everyone else, that this is not specific only to Sub. Your very valid complaints can also be applied to ____________ (fill in the blank) medical treatment. $400 for an initial induction fee is also not out of the norm. Again, the way healthcare works is the doc is expected to see about six patients an hour. He often can bill about $125-150 for those ten minutes with patient. If a Sub induction takes an hour - well you do the math. Even at $400 he is making less than if he saw six patients. Many docs are paying $100,000 + for malpractice insurance. Where/who do you think that comes from?

I don't like it anymore than the next person does. This is healthcare in America. Being a doctor today is not anywhere near what being a doctor was twenty years ago. With hundreds of thousands in medical school loans to pay back, huge insurance costs, and insurance reimbursement getting worse and worse, it is no longer the "cash cow" that it used to be. Just please don't think it is only related or happens with Sub treatment. It happens with pretty much everything.


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PostPosted: Mon Apr 18, 2011 9:11 pm 
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I hesitate to even get involved in this, but at this point I'm going to do so anyway. Donh is by far one of THE most knowledgeable people on this forum and always provides accurate information. If he isn't sure about something he'll say that outright and then proceed to obtain said information. I believe you did yourself a disservice by not reading the rest of his post. It was excellent - as always - and I would encourage you to finish reading it rather than to cut the discussion off at the knees.

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 Post subject: Everyone has a bad day
PostPosted: Mon Apr 18, 2011 9:44 pm 
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I read the whole post and what Donh said is pure bullshit. The OP is right on........with their information. I have 28 sub doctors in my city and only two take inusrance and they have a waiting list. One doctor wanted $450 for a meet and greet and my Dad has diabetes and he goes to his doctor.....pays no induction fee.....just copay of $15 and his meds are covered by insurance.

My great doctor will not take insurance even for drug test........and even though I have great insurance still tries to sell me the pills out of his office. My last visit he asked if I would be willing to be seen as a pain patient so he could take on a new patient.

Your right Donh is knowledgeable but is he stating his own opinon or does he have some facts othere than some comments from some of his doc friends......say comparing someone with insurance that has diabetes and how their care is covered by the same person with the same insurance seeing a sub doctor?

Trust me the OP makes some great points and some of us are lucky to have a doctor that sees them, takes insurance and writes them refills......like you Hat....it's easier to understand when you truly see how it works.

Perhaps someone would like to do another poll......as there is already one out there that says how much do you pay a month for visit and meds out of pocket........BTW why does a doctor accept insurance for pain patients but not sub patients and why should I file the insurance isn't that what they are there for?

Your right someone needs to address this .......I think it truly is Dr's taking advantage of drug addicts that are desperate and they don't care about our addiction. I have seen it at my dr's office......if you do not have the money before the visit.....you do not see the doctor.....period. Oh and Donh......you get about 5 minutes with him if your lucky.

Jim


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PostPosted: Mon Apr 18, 2011 10:29 pm 
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I’m not about to have a battle of wits with two un-armed men. You guys can believe what you would like to. I have been involved in healthcare for nearly 25 years and know what I am talking about. Both of you have been involved on the patient side only. You can choose to think and believe what you would like.

I re-read what I posted and stand by it. Now, having said that, I’m not sure I was as clear about who pays as I should have been. When I say that the diabetic, cancer patient or whomever is paying an induction fee, I didn’t mean to claim that the patient actually has to pay it out of pocket. What I am saying is SOMEONE (often insurance) is paying this. There are just no two ways around it. It is medical billing 101. Initial program set-ups, initial work-ups, etc. are very often billed at higher rates. They will bill at the highest rate they can get away with. Initial visits for new patients cost more. They just do. This is very common and goes on all of the time. It is not just in Suboxone. They may not call it an "induction fee" but it is happening - regardless what it is called.

Again, to be clear - or clearer, I don’t at all argue the point that for some really stupid reason (that I still have not gotten an answer to) a really, really high number of Suboxone doctors won’t bill insurance. I don’t dispute that at all. However, that does not mean that the patient can’t submit it to their insurance on their own and have it paid - which is what I clearly stated. Beyond that, go see a doctor for anything and you’ll be lucky to get 15 minutes with him/her. If you get more, you pay more. If a Suboxone doctor is charging a large induction fee and doing it in five minutes - that clearly is crap. It also is not common. Most certainly the medication refill Suboxone appointment lasts five minutes - perhaps ten on a good day. However, that is not billed as an induction or high level charge.

Am I making things more clear now? My point is there are “Induction” charges - called all sorts of things - put whatever name on them that you want - they take place in all sorts of medicine - not just Sub. I also stand by the fact that $400 does not buy you very much. Why the hell do you think health insurance costs so much? Healthcare is ungodly expensive. When you go to the ER, they pretty much have to and will see and treat you - regardless of your insurance status or ability to pay. That sort of happens at the urgent care or clinic as well. It don’t at all fly at the private doctor’s office - where it is pay to play.

I stand by what I said. Healthcare in America is screwed up, very expensive and in big trouble for all patients - not just Sub. Just because insurance is paying it does not mean it is not so. I only wish I knew why in the hell Sub docs so often won’t bill insurance - no one seems to want to or is able to answer that one. Healthcare is screwed up for Sub. I AGREE. My point is, Sub is not alone. It is screwed up for a lot more things than just addiction. You can find many of the exact same complaints about Sub doctors with all sorts of other doctors and all sorts of other illness. That is my point.


Last edited by donh on Mon Apr 18, 2011 10:40 pm, edited 1 time in total.

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PostPosted: Mon Apr 18, 2011 10:30 pm 
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The OP and ReRaise are right. This is a subject that has been really bothering me for a while now and it is getting worse. The stories I hear from clients and friends and other patients on sub...its immoral what is going on. OP is right....this has to stop and as I have said before we need to ban together and do something about this. We are the guinea pigs....we are the clinical trials as someone said a couple days ago....and as Laddertipper said we have no idea what is really going on but SOMETHING is and we will be thes one to pay the price...financially, physically, mentally....I do not trust this ludicrous 8 hour course that any physician, including a pediatrician, can take in order to prescribe Sub. If they changed this 100 patient cap then the psychiatrists and addictionologists, who are the ones who understand addiction, can be the prescribers....family doctors, internists....pediatricians...they know a little about a lot...we have a very complicated disease process and we need specialists treating us. I don't trust these dr who prescribe Sub and tell patients that there are NO sexual side effects, or to put a patient on 32mg of Sub for over a year, or say that w/d are all in our heads...or that we should be able to taper to 2mg and jump from there....and on and on.

Mark my words....we will continue to be the ones who suffer...and I'm not a sub hater...I'm on it. It has helped put my addiction into remission...but I'm very scared. I don't feel great on Sub any more. I have side effects. And I'm at 6mg. not a very high dose. but we have not seen the worst of Sub yet I am sure. My fear became more real when I read a study from Canada saying that they really do not know anything about the active metabolite of Sub...Norbuprenorphine.....THAT scared me.

We have to educate ourselves continually and have to be willing to fight back. There is power in numbers...I've said this before but we need to write to the politicians in our states...make some noise....demand better care. I'm sick of physicians and other medical professionals not knowing a thing about Sub....and then treating us like we are less than because of being on it....or, like a friend of mine who had an outpt procedure recently....they didn't give him enough sedation because it is my belief they were too scared to. I talked to the Dr who did the procedure and he alluded "Oh well this person has a high tolerance it was all we could do." BULLSHIT. They were unsure, not informed even though my friend told him well in advance about Sub.

Sub has saved lives and put addictions in remission for many. But there is a high cost and the financial piece is completely unacceptable. I'm lucky that I have a decent physician...he is a psychiatrist, spends 30 min with me, and charges me $130 that I pay out of pocket...and then pay $200/month for the Sub out of pocket. Its not as much as others but for me right now along with other medications I have to take, it is a huge burden.


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PostPosted: Mon Apr 18, 2011 10:32 pm 
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I had a feeling this was going to happen, and frankly I expect to get a lot more negativity, flaming and pushback over my post than actual help or understanding.

Disservice to who? Me?

The beginning of his post is BS. And I want everyone to know it was BS.

Charging an initiation fee is not a common practice among doctors for treatment of any disease outside of Suboxone, and to say it is is a disservice to every person who comes here for help or to vent.

I don't know if you two think I am some kid or what, but obviously he thought I did not have any other medical problems. And I didn't cut the discussion of by the knees. I cut it off by the head. It was that much BS.

Now, if you guys want to talk serious here and not try to excuse the unethical behavior and practices plaguing suboxone treatment, I am here to do that. A plan of how this can be fixed could be developed.

How do I just close this post? It won't go anywhere based on past history of this forum. Sorry to offend all of you who support unethical practices and defend sketchy doctors just because they hand out scripts for our crutch.


hatmaker510 wrote:
I hesitate to even get involved in this, but at this point I'm going to do so anyway. Donh is by far one of THE most knowledgeable people on this forum and always provides accurate information. If he isn't sure about something he'll say that outright and then proceed to obtain said information. I believe you did yourself a disservice by not reading the rest of his post. It was excellent - as always - and I would encourage you to finish reading it rather than to cut the discussion off at the knees.


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PostPosted: Mon Apr 18, 2011 10:36 pm 
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Un armed men? You're a (insert a good cuss word). You hit real low when you try to criticize a person's intelligence when you don't know one thing about the person. This shows how much of a putz you truly are and it is unfortunate that this has gotten ugly.

All I said was that you wrote BS. Now you personally attack me?

donh wrote:
I’m not about to have a battle of wits with two un-armed men. You guys can believe what you would like to. I have been involved in healthcare for nearly 25 years and know what I am talking about. Both of you have been involved on the patient side only. You can choose to think and believe what you would like.

I re-read what I posted and stand by it. Now, having said that, I’m not sure I was as clear about who pays as I should have been. When I say that the diabetic, cancer patient or whomever is paying an induction fee, I didn’t mean to claim that the patient actually has to pay it out of pocket. What I am saying is SOMEONE (often insurance) is paying this. There are just no two ways around it. It is medical billing 101. Initial program set-ups, initial work-ups, etc. are very often billed at higher rates. They will bill at the highest rate they can get away with. Initial visits for new patients cost more. They just do. This is very common and goes on all of the time. It is not just in Suboxone. They may not call it an "induction fee" but it is happening - regardless what it is called.

Again, to be clear - or clearer, I don’t at all argue the point that for some really stupid reason (that I still have not gotten an answer to) a really, really high number of Suboxone doctors won’t bill insurance. I don’t dispute that at all. However, that does not mean that the patient can’t submit it to their insurance on their own and have it paid - which is what I clearly stated. Beyond that, go see a doctor for anything and you’ll be lucky to get 15 minutes with him/her. If you get more, you pay more. If a Suboxone doctor is charging a large induction fee and doing it in five minutes - that clearly is crap. It also is not common. Most certainly the medication refill Suboxone appointment lasts five minutes - perhaps ten on a good day. However, that is not billed as an induction or high level charge.

Am I making things more clear now? My point is there are “Induction” charges - called all sorts of things - put whatever name on them that you want - they take place in all sorts of medicine - not just Sub. I also stand by the fact that $400 does not buy you very much. Why the hell do you think health insurance costs so much? Healthcare is ungodly expensive. When you go to the ER, they pretty much have to and will see and treat you - regardless of your insurance status or ability to pay. That sort of happens at the urgent care or clinic as well. It don’t at all fly at the private doctor’s office - where it is pay to play.

I stand by what I said. Healthcare in America is screwed up, very expensive and in big trouble for all patients - not just Sub. Just because insurance is paying it does not mean it is not so. I only wish I knew why in the hell Sub docs so often won’t bill insurance - no one seems to want to or is able to answer that one.

Just because the patient is not paying, does not mean the insurance is not paying. Someone is paying. They just are!


Last edited by eagleslanding on Mon Apr 18, 2011 10:59 pm, edited 2 times in total.

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 Post subject: Won't give up
PostPosted: Mon Apr 18, 2011 10:51 pm 
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Despite someone personally attacking me on here as being unintelligent, I am not going to give up spreading the word about the unethical behavior of doctors. Let's stick to the topic now that we've seen DOHh backtrack and provide"clarity" to his earlier incorrect post.

Here are the issues that MUST be addressed:

1. Why are most Sub doctors charging initiation fees, some as much as a few thousand dollars when no other treatment for a disease requires such fees?

2. Why can my family doctor prescribe me this medicine?

3. Why are there a very limited number of doctors who can prescribe suboxone?

The biggest problem right now is that Suboxone treatment has been taken over by sleazy, selfish, unethical doctors who could care less about you or I getting better. They won't see you until you pay that big hefty initiation fee and then they can kick you out of the program whenever they want so they can quickly get another person to pay that initiation fee. IT IS DISGUSTING.

Doesn't a doctor run this site? He knows this is going on every single day, so what is he doing about this unethical behavior that is hurting patients who need help or risk dying? This forum is plastered with people complaining about this; is the doctor who operates this site ignoring these known practices? I am not going after him by any means, but he is certainly well-known in the community of sub treatment and certainly could be persuasive to a national medical board or even a Congressional subcommittee. Has anyone ever asked him?

Ethical doctors will be sicked by this. I am an addict and here I am hating Suboxone because of this unethical doctor and the inability to find a different doctor and the overwhelming number of doctors who require BS fees before they will see you.

I want off Sub and I have no idea how to do it. My doctor won't tell me how because he says "this is a longterm treatment and if you are not committed to that then I cannot have you as a patient." I want off this damn puppet drug because there doesn't seem to be any support with getting this program straightened out.


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 Post subject: medical billing
PostPosted: Mon Apr 18, 2011 10:53 pm 
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Unless I'm reading wrong...nowhere in medicine do they make pts pay any kind of induction fee. Not in surgery, anesthesia, and my ex is an Ear Nose and Throat surgeon and I know there are no special fees that need to be paid in oder to be seen....if anything, many physicians try to help patients that pay out of pocket...esp when their medications are so expensive. Even with plastic surgery, that is usually cash and paid out of pocket, there are no special fees...maybe a down payment...but no fee to just get in the door.
I have a physician now, altho he is decent like I said, still does not use insurance for his Sub patients...WHY? I have no idea. he just says he doesn't. Period. Its all cash. Nowhere else in medicine have I ever seen this happen, not in my 27 years in healthcare.


Last edited by chinagirl on Mon Apr 18, 2011 10:59 pm, edited 1 time in total.

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 Post subject: Re: medical billing
PostPosted: Mon Apr 18, 2011 10:57 pm 
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He backtracked and now says that he didn't mean it is common for patients to pay these fees, but someone pays them. His backtrack response was even more ridiculous and as knowledgeable as one person said he is, he's lost all credibility with me on this issue at least. And then he decided to calm me unintelligent.

chinagirl wrote:
Unless I'm reading wrong...nowhere in medicine do they make pts pay any kind of induction fee. Not in surgery, anesthesia, and my ex is an Ear Nose and Throat surgeon and I know there are no kind of special fees that need to be paind in oder to be seen....if anything, many physicians try to help patients that pay out of pocket...esp when their medications are so expensive. Even with plastic surgery, that is usually cash and paid out of pocket, there are no special fees...maybe a down payment...but no fee to just get in the door.
I have a physician now, altho he is decent like I said, still does not use insurance for his Sub patients...WHY? I have no idea. he just says he doesn't. Period. Its all cash. Nowhere else in medicine have I ever seen this happen, not in my 27 years in healthcare.


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PostPosted: Mon Apr 18, 2011 11:45 pm 
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eagleslanding, check this out. My Suboxone doctor charged me $175 CASH per visit AND charged my insurance!! She was hitting my insurance up for another $200, of which, my insurance only covered $25!! Yeah, my doctor was smarter than the average bear apparently....getting cash payments and hitting my insurance. My wife is a Human Resource manager and I immediately had her look at the EOB (Explanation of Benefits) and my wife said that the way my doctor was doing it was bullet proof and ingenious. I almost shit all over myself when I realized I had to pay $350 every month for a 1 hour wait in her lobby and a 30 second visit with her!!

Infuriating didn't even come close to describing how I felt. I felt violated. That afternoon I started calling around to other Suboxone doctors in my area (within 50 miles) and none of them were currently accepting patients. Yep, I was screwed. Because my Suboxone doctor knew she was working with a captive audience, she knew she could charge us whatever she deemed appropriate....and she did.

BTW, when I first started seeing her, the monthly visit's were $100. Over the three years I was on Suboxone, she kept raising the fee and raising the fee. No explanations whatsoever, the receptionist just told me what the new amount was and that I'd have to pay it if I were to be seen. The doctor didn't start hitting my insurance until my final year with her.

To me, that's more crooked than a barrel of snakes.

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PostPosted: Tue Apr 19, 2011 1:31 am 
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I don't get why people don't want to acknowledge this problem. There are people everywhere who are dealing with shady doctors and/or doctors who know so little about Suboxone that it's quite terrifying that they can prescribe it. It's not as if there are only a handful of us who have these kind of problems. My doctor knows far, far less about Sub than I do. I'm on a slew of waiting lists to get into a better or closer doctor but so far, no luck. I'm driving an hour and a half and that's the closest doctor and he still should not have to ability to give anyone a med he cannot answer the most basic questions about. Over the years, when I think about how many horror stories I've heard of or seen unfolding, it blows me away that there isn't a great deal more outrage about it. Please, those of you who are lucky enough to have a good doctor and have had a good experience on Sub, don't let that blind you to the fact that this is out of control. Suboxone is just like any other med. It has to be prescribed responsibly, and for some odd reason, people want to believe so badly that everything about Sub is wonderful. It seems people have intentionally put blinders on and refuse to acknowledge the downsides to this business. That freaks me out. People call 12-step meetings cult-ish, but then, what is this?

Doctors hate insurance companies and if they don't have to deal with them, they won't. It's quite common for Sub docs to not accept insurance. It's a cash only business, even if they take insurance for treating non-Sub patients. I'm sure most of you guys must know that. If not, I guess you just got really lucky and didn't have to go through the ordeal of trying to find a doc that wasn't going to milk you dry. Of course, this happens in other areas of medicine, but it happens for the same reason. If docs can maintain their client base without dealing with the insurance hassle, they will. Where I moved from, in the Los Angeles area, so many doctors (dermatologists, primary docs, psychs) don't take insurance anymore because their patients are largely well off and can pay. It's the same with Sub docs, but the reason people can pay is because they have to because they are dependent on Sub and they need to get it. That sucks because it is taking advantage of an addict, not caring or looking out for the best interests of an addict. Okay, so that is what it is, but I cannot stand the BS about all this concern for addicts, when at least a good part of this whole thing is dollars and cents, plain and simple.

I'm glad people are finally talking about this stuff, because frankly, I'm been seeing all this weird stuff for sooo long and wondering why it was okay. I was apparently missing something. However, now I think I was right in my concerns. Why were doctors given such inaccurate information about Suboxone in the first place? I went to three meetings a week at a d/t hospital and watched one person after the other go through a rapid d/t (cause not everyone can or wants to do long-term Sub). They were fine the first week, but they'd be booted out by Day 10 on 2 mg and no script sent home. Poor people thought they were done with d/t when it had not even started. They'd go home and be sick as hell and told by the doctor they shouldn't be. It was HORRIBLE to see what these people went through. Then, everything changed. Now some docs now know people have to taper much lower. Some docs don't have any clue how to taper their patients. I mean, as my doc pointed out, the tabs only come in 2-mg, and many docs have never heard of the liquid taper. It's not as if the Here to Help people are teaching it. Where is the apology for giving people such wrong info? There is never an apology. There is a whole lot of crickets chirping. Normally there is a lot less tolerance for the medical field being so clueless.

Eagles, you asked a bunch of good questions. Your primary doc can prescribe Sub because docs only have to take minimal additional training to be licensed to script it. There's no requirement that they be an addiction specialist. Doctors with no other addiction medicine experience are scripting Sub. That should scare everyone!! Would you be okay with getting your heart meds managed by a proctologist? There are plenty of Sub docs, Eagles. It's just that soooo many people are now on Sub that as fast as they get licensed to script it, they've got a full load of patients.

Ethical doctors, and ethical people in general ARE sickened by this. I'm spoken to quite a few of them in my quest to find a doc who can truly explain this med to me. I'm really irritated at the lack of ethical behavior on the part of the doctors. I'm more irritated at the other people on Sub who don't seem to want to hear what many of us are going through and don't seem to be upset in the slightest at what many, many of us have gone through and are going through. We are supposed to be in this boat together. I'm glad people who need Sub have gotten it. I'd defend their right to be able to get it in the future. I'd hope they would be looking out for me too. I don't think that's what's happening. That is such a huge shame, and I think it will only contribute to the problems facing the future of this med. Whether people want to believe it or not, this med is not being responsibly prescribed in a large number of cases. People pay a high price for that. It's not a few people. It's not a few over-blown internet horror stories. It's a real problem. You can deny it and pretend it's not there. People being given Sub when they don't need it; people being given massive quantities they don't need for too long a period; people being given false drug information and having their side effects ignored....none of these things are going to secure the future of Sub. They will only threaten it. You want to be able to continue to get your Sub in ten years from now, look out for your fellow Sub-ers and make sure they are being treated fairly and don't deny their experiences because they don't match yours.

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 Post subject: Re: wrong
PostPosted: Tue Apr 19, 2011 3:17 am 
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eagleslanding wrote:
Sorry, I stopped reading your reply when you claim that patients do have to pay initiation fees for other diseases. You are wrong and I'm not reading what else you wrote because I don't think you are credible for information. Sorry to sound so blunt, but I have diabetes and I get my meds and see my doctor and my insurance covers almost all of it. No initiation fee. No BS.

My best friend had cancer and she didn't have to pay any initiation fees or other fees that the office won't even send to the insurance for reimbursement.

It is obvious that I have a firm belief about this because I see it happening to me and others every week, and it is also obvious that I am passionate about this situation changing for everyone. This isn't anger; I am not going to have someone reply with false information to fuzzy the truth even more. I admit, that does piss me off.

The fact of the matter is, if I go to a doctor and they find that I have diabetes, there isn't a $400 initiation fee, and to say otherwise is just protecting suboxone doctors who do this. Same with cancer. Same with any disease that's not related to drugs or alcohol.

You're not helping. If you don't think doctors are abusing this, then get your head out of the sand. Stories of doctor abuse plaster this forum. It's disgusting that nothing has been done yet.

And the argument "Get another doctor" pisses me off, too because I have tried and when all who I have reached out to have these fees, I refuse to talk anymore. This doctor's office said they did not have initiation fees. Now, I find out they did. The number of sketchy BS from this office is unbelievable.

I have called every office that is listed within a 30 mile radius and they either charge initiation fees, don't have room or won't take insurance. I've posted on her for doctors and I haven't received anything. Don't assume that I am just content with my situation, please, because I am not.

I honestly regret starting this program.



donh wrote:
I'm sorry to hear how frustrating your treatment has been. I can sense how upset you are. I don't at all want to make that worse. However, there really is more to all of this than you are seeing.

To start with, I am wondering if you are under treatment for any other chronic illness or have dealt with other doctors outside of a one time visit for a virus/infection or something. I ask, because what you are describing could very well be applied to all sorts of other areas of healthcare. What is happening with you is really not different with other areas. You ask about diabetes and if they have to pay these fees. Unfortunately the answer is yes.

While I most certainly agree that there are some bad docs out there that are milking the system, I also see all of this from the other side. I'm not a physician but I have been involved in healthcare much of my life and have many friends in healthcare. One of my doc friends is so fed up with the insurance crap that he now is a corporate pilot and just moonlights part-time as an ER doc. He says that he no longer treats patients - the insurance companies do. Another friend gave up his practice and became a teacher at a medical school. He was a surgeon and simply could not make ends meet. The crap that goes on with insurance is not in any way, shape, or form tied only to Suboxone. Plain and simple, $400 does not buy much at all in today's healthcare arena.

As for the drug testing, it is very, very, very common - including testing for Sub. Why on earth would they test for Suboxone you ask? Simple, there are people out there who fake needing it, get it prescribed and sell it for $25/tab - or whatever the going price is. Therefore, many docs now test to make sure it is in the patient's system. The same thing happens to pain patients. Chronic pain patients who are on daily opiates are very often tested to make sure they are taking their medication. Again, the only reason is diversion. There are those who will try to get pain meds just to sell. It is not a scam or unethical to test you for Sub. I'm not sure what is going on with not submitting it to insurance. That does not mean that you cannot submit it to your insurance on your own. In my case, my doc tests me as well. However, he does not charge for it. It is simply included in his overall fee. If I fail, it is then sent to a lab and that is billed. I have to pay for my Sub out of pocket and then submit it on my own to my insurance for reimbursement. You can submit claims on your own to your insurance.

I don't expect this to make you feel any better. I just want to point out to you and everyone else, that this is not specific only to Sub. Your very valid complaints can also be applied to ____________ (fill in the blank) medical treatment. $400 for an initial induction fee is also not out of the norm. Again, the way healthcare works is the doc is expected to see about six patients an hour. He often can bill about $125-150 for those ten minutes with patient. If a Sub induction takes an hour - well you do the math. Even at $400 he is making less than if he saw six patients. Many docs are paying $100,000 + for malpractice insurance. Where/who do you think that comes from?

I don't like it anymore than the next person does. This is healthcare in America. Being a doctor today is not anywhere near what being a doctor was twenty years ago. With hundreds of thousands in medical school loans to pay back, huge insurance costs, and insurance reimbursement getting worse and worse, it is no longer the "cash cow" that it used to be. Just please don't think it is only related or happens with Sub treatment. It happens with pretty much everything.
[/quote
amen! their is always something that rubs me the wrong way when sub docs say"well, this is cheapoer than buying on the street" donH is biased because of his experience in the healthcare facility and jaded blah blah... b ut, the fact is my granny doesnt get charged for an induction when she went to see the doc for alzheimers....this situation stinks,...as to hatmaker, u must have an opinion! don h is definitly jaded and im glad this topic is finally being addressed!


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PostPosted: Tue Apr 19, 2011 5:27 am 
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Oh Yeah, I forgot to mention that she gave me the line about tapering down to 2mg and jumping off and I would only experience 3 days of withdrawal......hahahaha, can you believe that shit!!! I almost pissed my pants when she told me that. So, my next logical question to her was....how many people have you successfully detoxed off of Suboxone and her answer was.....drum roll please.....NONE!! I was her first patient to ever come off of Suboxone. I was with her 3 years and she had been practicing for 2 years prior to that. So, over 5 years, she had 1 patient discontinue Suboxone, but she somehow knew that if I tapered down to 2mg that I would only have 3 days of withdrawal!! Give me a break!!

She was also one of those super caring, hugely concerned about my well being doctors who sent me home to do my own induction!!! (notice that sentence dripping with sarcasm please) Thank God I knew just enough about Suboxone to know that I had to be in withdrawal before taking my Suboxone or I would have ended up sucking pavement.

Please do not take any of my comments as hatred aimed at Suboxone itself, Suboxone worked for me. It got me out of active addiction, it gave me time to get my head screwed on straight and when I was ready I quit taking it.

Honestly, I don't think anyone on here is really mad at Suboxone itself. It's some of the dumbass doctors who prescribe it and the complete lack of accurate information regarding this powerful drug that has so many upset.

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 Post subject: Ok....
PostPosted: Tue Apr 19, 2011 6:27 am 
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I'm a painter, if I go out and bid a job and price it to high, the customer GOES somewhere else... Its that simple, so may people around here want to fight city hall over moral or immoral shit, The Dr in the 1st post has broken NO laws, hes just expensive and probably tired of druggies... he owes no one nothing, including any fucking ( I Think this the 1st time I've ever printed a bad word ) excuses to anyone, Maybe you would like some cheese with your wine !!!!!! Whats with all the ass kissing around here lately, I get really tired of trying to be nice to people who WANT to be un-happy... If I were the DR I'd throw your ass out of my office !!!!!!


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