It is currently Thu Aug 17, 2017 12:19 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 11 posts ] 
Author Message
PostPosted: Tue Jun 26, 2012 11:36 am 
Offline
Average Poster
Average Poster

Joined: Tue Jun 26, 2012 10:52 am
Posts: 6
Hello, this is my first post on the site, I'm just looking for some information and/or advice from those that have been where I am now. I recently had my previous Health Insurance Cigna (through my previous job which did cover my suboxone prescription for a $30 copay) ended. Since the small company I am working for currently doesn't offer any benefits I kind of panicked as my 60 film a month script would now cost close to $400 or $500. I ended up applying to a couple of insurance companies but omitting any mention of suboxone, before I knew it, BCBS accepted me and sent me a card. Due to all the uncertainty, I've been trying to drop my dose as low as possible and have successfully cut down to 8mg/day, my next refill will be in about 3 or 4 weeks (about 2 months from when my new policy started). I've read quite a bit on this and other sites and was thinking/hoping I might be able to change the prescribing Dr. and the pharmacy where the script is filled (to a Dr. and Pharmacy I've never used before) and get BCBS to help with my prescription cost. Now I'm wondering if doing this and therefore "per-certifying" myself as an addict (which apparently hadn't been done yet judging from how quickly BCBS provided me coverage) might be a worse long term decision. I'm not sure what chance there is of BCBS really helping with this prescription and thus I don't know if paying for this insurance right now is the right thing for me to do. I would really appreciate some feed back and/or advice from someone who knows about situations like mine. Thanks


Top
 Profile  
 
 Post subject:
PostPosted: Tue Jun 26, 2012 1:12 pm 
Offline
One Month or More
One Month or More
User avatar

Joined: Sat Jun 23, 2012 9:11 am
Posts: 39
I have a relative who has no insurance and his Dr. prescribes the generic pill instead of the film and his out of pocket cost is under $200 a month for the medication, i dont know if that is an option for you or not. Good Luck and Best Wishes


Top
 Profile  
 
 Post subject: A tough one
PostPosted: Tue Jun 26, 2012 1:43 pm 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2801
Location: Southwest
Hi Maucat and welcome to the forum. I don't think anyone will be able to tell you what will happen with BCBS and the Suboxone. All you can do is have the doctor submit the claim and see what they do.

There is a possibility that they will drop you for not disclosing the Suboxone treatment up front. Or they might just let it slide and pay the bill. You won't know until they get billed. And with a company that large it may take months before they catch it.

Congratulations on finding recovery from Suboxone and I surely hope you can continue treatment regardless of how the insurance thing works out. Can you even afford to pay for it w/o insurance? That is a lot of money to fork out every month, but then you also have to look at how much you were spending while abusing your DOC. If you were spending that much money before you got on Suboxone then you should be able to handle it now. Just a guess of course.

Either way it turns out, do whatever you can to stay on the recovery road.

Good Luck

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
Our Sponsors
 Post subject:
PostPosted: Tue Jun 26, 2012 4:32 pm 
Offline
Average Poster
Average Poster

Joined: Tue Jun 26, 2012 10:52 am
Posts: 6
Rule62, thanks for the well wishes and I'm very glad to have found recovery myself. I know my life is 250% better than it was before. To answer your question about the prescription cost, I could pay it out of pocket if I absolutely had to (I really just don't want to). I've been on suboxone for about 3 years now and my previous insurance (group insurance through my previous job) picked up the tab leaving a $30 co pay for me for that whole time. When that insurance lapsed, I began looking into other insurance companies thinking that none would accept me because (in my mind) I had to be certified. I was blown away when BCBS accepted me for coverage. Through some reading I've done on this site and some others, it seems the way insurance companies deny coverage for suboxone is by either getting the Dr. to give the date of diagnosis in a "pre-certification" form or by finding the prescription history at the pharmacy filling the order. I thought if I were re-diagnosed by a new Dr. and then filled the script at a pharmacy I had never used before, I might have a chance in hell at getting BCBS to cover the prescription with a co pay. The possibility that I might have to pay for everything out of pocket is what prompted me to taper down my dose as low as possible in preparation.


Top
 Profile  
 
 Post subject:
PostPosted: Tue Jun 26, 2012 4:40 pm 
Offline
Average Poster
Average Poster

Joined: Tue Jun 26, 2012 10:52 am
Posts: 6
I guess my concern is, if I'm not precertified as an addict right now (which apparently I'm not since they were so quick to cover me), that trying to get BCBS to cover the script and being denied will not only make me pay for the whole script myself, but also certify me as an addict as far as future health insurance coverage is concerned.


Top
 Profile  
 
 Post subject:
PostPosted: Wed Jun 27, 2012 8:20 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
Hi maucat -

I'm not familiar with the terms "certify" as it relates to insurance. When you applied with BCBS, did you answer questions about preexisting conditions? Did it specify anything about substance abuse or addiction? How did you answer those questions? Did you deny having been treated for addiction?

Do you have any pain condition(s) that suboxone helps you with? Is it possible for a doctor to write your sub prescription for pain control? That would allow them to approve the script AND it would keep "addict" from going into your insurance file. It is cutting corners (putting it mildly), but it's a thought I had.

I would imagine BCBS could find out easily enough that you have been treated previously for addiction. If you weren't truthful on your application that could be cause for them to terminate your coverage or for them to not cover said preexisting condition (I think). It could depend on the policy; often insurers will cover preexisting conditions after a certain waiting period.

Unfortunately, all insurance carriers are different. But generally speaking, once we've been treated for addiction/sub abuse and it's paid by our insurance - any insurance - it's pretty much on our "records". Now all I mean by that is if another insurance company wants to hunt that info down they probably could (not that the info magically flies into their lap when they start your coverage).

I know this isn't a lot of specific information for you, but it's about all I've got. Good luck to you. I hope you can get and keep your suboxone coverage. That's a lot of cash to have to dole out every month. I know to me, if I don't have $400, it may as well be $4000.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


Top
 Profile  
 
 Post subject:
PostPosted: Wed Jun 27, 2012 1:19 pm 
Offline
Average Poster
Average Poster

Joined: Tue Jun 26, 2012 10:52 am
Posts: 6
I see people refer to "being certified as an addict" in their posts with respect to some insurance database, that's what I was referring to with that word but I don't know if there's any truth to what I've read in these posts. I was given a telephone interview and was asked "have you been treated for addiction in the last 5 years?" I began to tell the person about treatment I underwent about 7 years ago now and she stopped me and said that it didn't matter. I pretty much left it at that (I'm probably wrong for that but what can I say) They confirmed coverage about 3-4 days after the interview and after getting my chart from my GP (different from my sub Dr.) Now I don't know whether to pay the monthly insurance premium to keep the coverage (which I really don't need currently if they won't help with my suboxone script) or to just let it go. From what you said in your last post, I wouldn't be any worse off if I tried to get them to cover it and was denied. But the only way for me to have a prayer at getting it covered would be for me to go to a completely new Dr. and get a new prescription, will that be a problem if there are refills left on my last script from my previous Dr? I'm hoping that it won't be a problem as long as I never try to fill them both. Still part of me wonders if it wouldn't be better to just drop my dosage as low as possible and pay out of pocket so I wouldn't have to deal with or worry about any of the things I've mentioned in my posts previously.


Top
 Profile  
 
 Post subject:
PostPosted: Thu Jun 28, 2012 5:53 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
Just to be clear, I'm not 100% sure about anything I told you - I'm just hypothesizing, more than anything. I'd hate for you to end up paying out of pocket or getting denied based on my words.

We used to have someone on the forum who worked for (or who's spouse worked for) an insurance company and they knew all about this stuff, but I just can't recall who that was...

I guess you have a decision to make. So the first thing to do would be to determine your options. 1 - do nothing and keep filing claims as per usual; 2 - switch over to paying cash; 3 - part 1 and 2. (Meaning, what if you paid cash for a month or two THEN got a new doctor and filed the claims?)

Right at this moment (6am'ish), those are the options that came to me, but I'm sure others can come up with other options for you (maybe those who have slept more than I). But if you have to, actually put pen to paper to write out your different options and their pros and cons.

I really wish I could provide more specific help for you. Your situation sucks!

The other thing I thought of is to check out the new Health Care reform law and see when the no-preexisting condition thing goes into effect. Parts of that law have taken effect while others have yet to.

I hope this works out for you. It would be a damn shame to have said insurance and not be able to use it.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


Top
 Profile  
 
PostPosted: Mon Jul 02, 2012 1:05 pm 
Offline
Average Poster
Average Poster

Joined: Tue Jun 26, 2012 10:52 am
Posts: 6
I'm trying to weigh my options and obviously, what comes into play is whether or not my new insurance will cover the suboxone script. I'd like to find out if they will before I try to get them to but I'm also thinking that calling on the phone to check on that issue could possibly ruin any chances I had of it being covered in the first place. The reason I would like to find out before I try to file the claim is that it will cost a lot more in Dr's fees and insurance premiums to file it, be denied, and then move on. I really appreciate your time and advice a lot, there's no where else I can find to ask these questions.


Top
 Profile  
 
   
 Post subject:
PostPosted: Mon Jul 02, 2012 2:43 pm 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
Hi Maucat -

(I see you found the thread.) Most insurance companies (including the prescription riders) have websites. For example, mine is MEDCO and when I want to know if a med is covered I just sign into their website and there's a feature where I can look up the medication and find out! Do you have your ID card? Check on the back for the website or just Google the name of your medication rider company and register if you're already covered. I'm 99% sure that you should be able to check coverage this way. And you won't have to deal with a person. If you can't do it this way, then you can call and speak to a person and find out that way. I have no idea if they'll ask you questions about it or not.

OR you can always go to a pharmacy and show them the card and ask if they can check without a prescription if suboxone is covered. They might be able to check it for you. Just a thought.

Good luck! :)

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


Top
 Profile  
 
 Post subject: ObamaCare
PostPosted: Wed Oct 10, 2012 12:46 am 
Offline
Power Poster
Power Poster

Joined: Thu Dec 01, 2011 12:43 am
Posts: 75
I HATE Obama Care...BUT doesnt the new regulations exclude restricting pre-existing conditions? In that case they have to cover it. If they get mad that you didnt disclose addiction on your application just play dumb and tell them that you didnt think is was a medical condition..who knows?!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 11 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