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PostPosted: Mon Oct 20, 2014 2:19 pm 
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I'm in the process of appealing UHC to cover Suboxone strips instead of Zubsolv for me. I tried the Zubsolv and it was a horrible experience. I had to write the appeal myself because my doctors office (who I pay a couple hundred dollars every month) won't file appeals. Which pisses me off in of itself! Anyhow...last month I got them to fax in to the appeal dept that I was having issues on the zubsolv but UHC denied it because whatever they sent didn't have the word "appeal" on it. Which is complete bs. They knew it was an appeal, if they read it! I'm so angry with UHC and how petty they can get just to not cover a medication. Anyhow...back to my question: I'm just wondering if anyone has successfully appealed UHC (or any insurance for that matter) to get Suboxone covered? This waiting game is ridiculous and I'm worried they are going to come up with some other bs reason not to allow this appeal. Like the fact that I wrote it, not my doctor.


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PostPosted: Tue Oct 21, 2014 4:38 pm 
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I guess no one so far this week has had the experience you are having. This post will bump it up to page one again.

Keep pushing and don't let up. And yes, your doctor should be on board with you on this subject. If the medication was for cholesterol then they'd listen. It's discrimination at its finest.

Now you got me pissed off too!

rule

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PostPosted: Tue Oct 21, 2014 5:42 pm 
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Thanks for the bump rule :)

And yes...it angers me so much the treatment we "addicts" tend to get. Even when we are trying to better ourselves. To be quite honest....who got a lot of us here to begin with? Doctors. Insurance companies. Drug companies. Pharmacies. Drug dealers in white coats. Driving their nice cars, living in their nice houses. I wonder how they sleep at night.


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PostPosted: Thu May 26, 2016 10:38 am 
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Have your doc appeal it so it looks better. That's how I get my stuff approved ....if the doc calls and explains why the meds you been taking is better off for you then they almost have no choice to allow it


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PostPosted: Sat May 28, 2016 2:13 am 
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This is standard treatment for United Healthcare, and I really don't think it's just with addict medication. I was on a 2mg strip of suboxone and when I changed to Zubsolv I had to go up to 1 and a half of the 1.4mg pill. My doctor had no problem bumping me up to that dose.

My attempts at getting prior authorizations have been laughable. I ran into the same issue of not having an exact word written on the request and having it be denied. I spent 45 minutes on the phone with 3 different representatives to get the exact wording to make the authorization go through "expedited". It was completely annoying!!

Amy

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PostPosted: Fri Jul 07, 2017 9:28 pm 
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i'm currently appealing highmark.
i was told over the phone before starting treatment that i would be covered and would need to file a major medical claim since the clinic didn't take insurance.
after submitting the claim SIX!!!!! times. someone finally looked at it and denied it.
so i was told by phone i would be covered.
in my handbook inpatient and out patient drug addiction care is covered
and in the list of benefits drug addiction has a green light. meaning it is covered 100%.
i chatted online with a representative after the claim was denied. and she said methadone treatment is not covered! i've never been on methadone! so was this denied because they think I was getting methadone? do they not see the sub script?

now, highmark always covered my prescriptions for subs, i just want reimbursed for the $1350 i paid out of pocket for dr visits!
one one hand i want to raise hell, on the other I don't want to draw attn to the fact that they are still covering my subs.

what do you think?

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