It is currently Sat Aug 19, 2017 12:46 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 3 posts ] 
Author Message
PostPosted: Sat Jan 16, 2016 1:20 am 
Offline
New Poster
New Poster

Joined: Sat Jan 16, 2016 1:11 am
Posts: 1
Hi!

I've been on pills since 8 years old (long story) and narcotics since 11(I'm 22 now, will be 23 in Oct). I have been buying subs off a family friend and my brother for years now, but since I have my own insurance now, I want my own to save money. I'll be starting to call drs either tomorrow or Monday, but I have a few questions that I'd be happy if some of you could help me with:

Back info: I live in NE PA and have medicaid through Aetna. My insurance says it covers outpatient drug treatment and medication as well as methadone, so I'm hoping they'll pay for it, because we just don't have the money at all to afford it, at all, hence why I'm trying to get my own script instead of paying $15 per strip forever, I just can't afford it anymore. Here's my questions:

1. After the dr visit is set, or even before that, do I mention the medicaid or no? Many of my friends and family have medicaid and go to the sub drs, but some also mention having to pay per visit, which would be a problem.

2. How does Pre-Auth work? Do we have to call? Does the Dr call? What to do?


Pretty much, I'm just looking for any helpful hints, how to make getting that script as painless as possible, what to say, what not to say? Will medicaid pay? If so, what for? etc. I ask you all to help me out if you have any advice I could use. Thank you! Also, you guys may call me Ry, I prefer it over Mariah.


Top
 Profile  
 
PostPosted: Sat Jan 16, 2016 3:27 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4127
I don't know the answers to some of your questions, but I'll try to help. First, it would be helpful to know what dose you are on and how many strips you buy per month.

There are sub doctors who only accept cash, so that is one of the questions you have to ask over the phone. If you find a doctor who takes medicaid and has room for you that is good news. If the doctor charges a fee over and above the amount your insurance is billed you may have to live with it if you can't find a better situation. Even if you pay for the office visits, your medication may be paid for by your insurance.

There is really no way to find out about the various doctor's offices and your insurance without calling them. Some insurance companies require that you use a specific bupe medication like Zubsolv, for example. You just have to roll with what is required.

The good news is that you're young and you've got time to better your circumstances. A second job could help make ends meet. Are you acquiring a new skill set or going to college?

One more thing. Sometimes you really have to put some time in on the phone with your insurance to figure out how to get your treatment covered. If they turn you down, try again. Yes, the doctor's office will help you obtain a prior authorization, but you may figure out how to expedite the request if you hammer away at your insurance company. Be ready to be diligent! Good luck!

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Tue Jan 19, 2016 1:02 am 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1543
I've heard patients talk about doc offices that won't do PA's, and I consider them to be irresponsible-- since the PA has become a standard part of medical practice (miserable as it is). As Amy said, don't be afraid to talk with your insurer-- but in WI, the PA form needs the doctor to sign, so it really is part of his or her job.

Docs who don't accept medicaid can still see medicaid patients, but those patients have to pay out of pocket. I wrote a long-winded post a couple days ago about the financial stuff-- but the brief thing is that the only way to make medicaid work is to have very short patient visits. I choose longer appointments and don't take medicaid. Doctors who are part of hospital networks are more likely to take medicaid because hospitals make much more money for surgical procedures, and can also bill for a bunch of little things (like facility fees, or charging $100 for every tylenol or band-aid).

You have a right to know the costs up front, and I encourage you to ask-- because otherwise you could get hit with a bit bill and be expected to pay. I'd want to know a couple things-- such as the basic fees, but also whether you pay for lab expenses, for bloodwork, for the induction, for mandatory counseling, etc.

Good luck!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 3 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group