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PostPosted: Mon Apr 27, 2015 5:59 pm 
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Hi Everyone, I have a dilemma that I'm hoping to get advice on. Hopefully this is the right place to post it.

I've been on sub for a while now and I'm doing really great on it. And I mean my life has completely changed for the better.

I've been getting pre-auth every 6 month/3 month/1 month...it just depends on how my insurer (medicaid/staywell) feels that particular month I guess. I've always had to do a bit of a dance but eventually got it approved before I ran out.

This time around that is not the case.

I'm working on pre-auth but insurance keeps telling me they haven't recieved anything from my doc. Of course my doc says they have sent it. This has been going on for more than two weeks.

I don't know if I'm being lied to or if it really is a communication breakdown between my doc and ins. But at this point I'm fed up.

I want to move on from this whole song and dance and really focus on my recovery. Because doing this every 30 to 90 days at random has not helped me at all.

I think it's best if I find another ins or just start paying out of pocket. I know it will be expensive but it's going to be the only way I can focus on getting better. The time I spend in fear, calling to check the status of the pre-auth could be spent making the money to pay cash.

Does anyone have any advice on this? Has anyone else given up and just went straight to cash to avoid all this?

Please share any advice you have. It doesn't have to be about insurance or coupons - although that would be great too - but anything about why you made this decision, how you're handling it, what helped, is it better, etc...


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PostPosted: Mon Apr 27, 2015 10:02 pm 
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Hi Bambam
This month IMO, you should pay out of pocket. Then I would get a copy of pre auth from the doctor & call you insurance. Ask the doc to add that this medication should not be stopped abruptly. Get any paperwork together and start hounding the ins company. The contract is between you & ins so you have more pull. Get them to put in writing that only a 90 day pre auth is acceptable. I hate when insurances do this and they do it allot. If you start making noise there will change policy for you. Just my opinion.

Good luck


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PostPosted: Tue Apr 28, 2015 1:19 pm 
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What Tiki says! She has expertise in this area, so listen to her.

Besides, if you give up, the insurance company wins!! I hate it when the insurance company wins!

If you have to pay out of pocket, ask your doc for a prescription for one of the new generics. I'm pretty sure that zubsolv has a good coupon.

Amy

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PostPosted: Tue Apr 28, 2015 1:41 pm 
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I pay cash for my clinic and my meds because I have no insurance. I've been doing this for 3 yrs, it's definitely expensive. I take the strips 8mg. If u do decide to go cash and take suboxone brand, they have two really good coupons on their website that I use each month. Definitely check those out if it applies to ya. But if I were u, and had insurance, I'd try everything under the sun to straighten it out so u don't have to pay straight cash. Paying cash has a whole new set of worries too. Having to come up with that amount every single month can sometimes be challenging. Life happens and unexpected expenses come up that can be stressful. I'd never advise anyone to go to cash if they have insurance unless there just wasn't any other options. Good luck, no matter what I have to pay though, it's definitely worth every penny, I'd do whatever I had to just to make sure I stay in recovery.

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PostPosted: Tue Apr 28, 2015 4:49 pm 
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Thanks for the replies everyone! I've gone ahead and paid this month out of pocket. They say I have 7 days to be reimbursed at the pharmacy, so hopefully I can make that happen.

It cost me over $700 but as you all know, it's money well-spent. Maybe I will be reimbursed, but I'm sure that next month's will be covered, as long as I keep on grinding the insurance.

Paying cash isn't ideal, but it was a lot easier than jumping through hoops for a pre-auth. (now to replenish the funds)


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PostPosted: Tue Apr 28, 2015 6:00 pm 
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Another issue with paying cash is that the cash price is higher than the insurance cost due to group/bulk buys and negotiated pricing agreements. It's a shame that those without insurance have to pay the most.


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