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 Post subject: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 12:56 pm 
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Hello everyone! I'm hoping someone may have advice for me.

I've been off prescription pain medication since 1/7/14, almost 2 years and have been on Suboxone maintenance. I recently just switched jobs and my new insurance became effective this month. Unfortunately, it is far inferior to my last insurance plan and not only do I need to meet a $2,700 deductible before it begins covering anything, prescriptions included, but Suboxone is on the exlcuded list and will never be covered.

I saw my doctor on Friday and he switched me to Subutex due to the cost savings and the fact it will be covered once my deductible is met. I attempted to fill my prescription yesterday and was told it requires prior authorization. I left a VM for my doctor yesterday and today and my insurance company is closed until tomorrow. Today is day 30 of my last script and I will be out for tomorrow morning. I also have to go to work before the pharmacy is even open. As its a new job, and a great opportunity, missing work or going in late is not an option and I'm freaking out.

Is there anything else I can do? My insurance isn't even paying a penny for this prescription so I don't understand why this is even needed?!? The pharmacist remembers me from my addiction days and treats me like utter crap so I know I will get the eye roll and turned away if I even dare mention not to process it through my insurance. Heck, I shouldn't have even given them my updated insurance card but that probably would have set off red flags anyway.

There is no alternative to this medication so I don't understand why I even have to go through this. It's so frustrating to have to do what I call "the walk of shame" each month with the judgemental eyes at the pharmacy, especially when I am doing the right thing.


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 1:36 pm 
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Hi NY, I have heard people talk about coupons being available. I don't know who makes subutex but find out and go to their website. As far as the pharmacy goes, us another one! They are a dime a dozen in my area and especially if you are paying with cash, you could probably find one that is open twenty four hours. If you have what you need for today, with the half life of suboxone, you will probably be fine until tomorrow after work. I am sure someone will respond soon who might have more suggestions for you. In the meantime, welcome!


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 1:37 pm 
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Well, my doctor just called and said "it takes 72 hours so you have to wait until tomorrow." I know that all he needs to do is call the auto-attendant at my insurance company. Part of me is sympathetic to him to him needing a day off. However, the other part of me knows it comes with the territory of the industry he's in. I work in IT and if people are working at any given minute of any given day and something goes wrong, I have to be available.

I know deep down that this isn't the end of the world and I will live. My sobriety is too important and there will always be times where life is just not fair. I just hate the hoops the system puts people through because there was a time where this might have pushed me over the edge.


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 1:38 pm 
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Make sure that your doctor's office tells the insurance company to expedite the authorization and ask for a 5 day emergency supply. I had to do that one January myself. If you don't ask them to put "expedite" on the claim they have, like 15 business days to make their decision. If you end up missing a day or two you will not go into withdrawals. The sub is stacked up in your system and a couple days of missing it won't hurt you. Talk to your doctor's office. You should be able to purchase the subutex out of pocket if your insurance keeps delaying. Also, keep calling your insurance daily. Ask about the emergency supply. It will be OK!! :)

Amy

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Done is better than perfect!


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 1:47 pm 
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I'm confused! What takes 72 hours? If you are paying cash, they don't need authorization right? He gave you a script on Friday. Are you putting it through the insurance so they know when you have met the deductible? You should be able to just fax copies of your receipts.


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 1:53 pm 
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Thanks Michelle. It has nothing to do with the cost as I was expecting paying for it all out of pocket. I have not met my deductible (I've only had this plan for 15 days now) so I am responsible for the entire cost. But that's the whole reason I'm upset over this. Why do I need to wait for an insurance pre-auth when they're not paying a penny for it? If this was an rx for Lipitor or any other non-controlled substance, the pharmacy would just fill it and let me pay. But because I'm a recovering addict, they have to be cautious. I just wish they'd treat me like a human being at the same time.


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 2:06 pm 
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I think it's my doctors rule. His office needs 72 hours (aka, gives him an excuse not to address these requests on the weekends). However, he did say he would call the pharmacy but then his receptionist called and it appears she is taking care of it.

I know there's a chance I could go into the pharmacy and explain all of this but aside from the hassle of bringing my 3 yr old, the thought of it all paralyzeses me with anxiety. I hate confrontation. Maybe also because it reminds me of the days where I thought I was so smart trying to convince them to fill my pain pills early which was NOT a good time in my life.

Thank you for your response though! I feel better just getting my frustrations out to understanding ears (eyes?!?).


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 Post subject: Re: Pre-Auth?!
PostPosted: Sun Nov 15, 2015 3:00 pm 
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Ok, I get it now! So sorry you have to deal with all of this! Sounds like your Dr is going to get it handled! Hope you enjoy the rest of your day!


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