It is currently Tue Aug 22, 2017 7:12 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 5 posts ] 
Author Message
PostPosted: Tue Aug 19, 2014 12:21 pm 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
That's pretty much what the rite aide pharmacist told me. So, over the past two weeks or so I've been playing phone tag between the pharmacy, the doctor's office and my insurance company United Healthcare. First the pharmacy tells me "Oh we were just running it through plain Medicaid and it was covering it before," then they said they'd try it with UHC, which came back saying Doctor Authorization required. I called the doctor. The doctor called them. The pharmacy told me that UHC will only pay for a week's worth at a time. When I was getting the 8mg pills the insurance was covering my exact monthly dose (15), all at one time, but now that I'm on the 2mg pill (45 a month at 3mgs a day, one less mg than my previous 4mgs) they no longer cover the full prescription but are making me split up my prescription into weekly intervals. Just now my doctor called the pharmacy again to tell them they submitted the paperwork to allow me pick up my monthly supply all at once since they know what a pain in the ass it is to find transportation to and from the pharmacy every week, and the pharmacy called my insurance then called me back to tell me that the insurance said they never received the fax from my doctor so now my doctor had to resubmit the paperwork all over again!

I swear it was easier when I was paying cash! Oh, speaking of paying cash apparently you risk losing your insurance coverage altogether if you pay cash for a medication when you have health insurance. That's what the pharmacist told me when I asked about it. It's all a big mess I'm hoping will be cleared up soon. Thanks for listening...I mean reading!

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
PostPosted: Tue Aug 19, 2014 6:52 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4137
That sounds totally screwy! I have a couple of questions.

1. Has United Healthcare given you the prior authorization yet? Because that's the only reason I can think of that you wouldn't be able to pick up the entire prescription at once.

2. Have you called United Healthcare (repeatedly) to find out why you're having trouble getting your entire script filled? I have United Healthcare myself andI had to work very hard and talk to numerous people to find out that my prior auth. had been declined because my doctor wrote something wrong on the form!! They gave me a weeks worth of sub while I was waiting.

If they are dragging their feel, ask your doctor to write "expedite" on the prior auth. form and send it back in to them. Above all, be persistent!!

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Aug 20, 2014 8:53 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
Amy-Work In Progress wrote:
That sounds totally screwy! I have a couple of questions.

1. Has United Healthcare given you the prior authorization yet? Because that's the only reason I can think of that you wouldn't be able to pick up the entire prescription at once.

2. Have you called United Healthcare (repeatedly) to find out why you're having trouble getting your entire script filled? I have United Healthcare myself andI had to work very hard and talk to numerous people to find out that my prior auth. had been declined because my doctor wrote something wrong on the form!! They gave me a weeks worth of sub while I was waiting.

If they are dragging their feel, ask your doctor to write "expedite" on the prior auth. form and send it back in to them. Above all, be persistent!!

Amy


They had it prior authorized when it was a higher dose/different tablet and different pharmacy just fine. The problems started when my doctor called Rite Aide during my appointment with him and switched me there from Walgreen's because he doesn't like Walgreen's. An update: I spoke with the receptionist who handles all the insurance and pharmacy issues for the doctor, aside from walking the two feet from her desk to his office to have him sign something or make a phone call, when I came in last night for evening group therapy and she told me it's all been taken care of and went to get the fax from the printer and then she looked at it again and like "Oh, I'm sorry! I just saw the word 'approval' and thought it had gone through!" What happened was the form was acknowledging the doctor's request for prior approval/authorization of the medication and she didn't read the rest of it until I got there. We figured out the problem, though. They hadn't been UAing me every 30 days because my doctor said, pretty much he didn't see the point since my previous UAs were always good and I've been as much of a model patient as I can be. But, in order for the insurance to cover it they have to submit UA results every 30 days. So, I did the UA last night before group started and they said it will be a few days to get it back but in the meantime the insurance have approved coverage for two weeks supply of the meds while it's sorted out so that's better than having to go to the pharmacy every week at least. What's really screwy is why they didn't catch the "Oops, forgot you need a monthly UA to get your meds paid for!" sooner.

Now, I have a question for you. I have been told that my insurance will only cover a year of treatment services including paying for Suboxone, since you also have UHC I was wondering if it's the same for you and if so do you have any advice on how to extend that time limit? Thank you, Amy!

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
Our Sponsors
PostPosted: Wed Aug 20, 2014 10:27 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4137
I have not heard of the one year limit, so I'm not sure about that. If I do hear/read anything about it I will make sure to find out more and comment here. Where did you get the 1 year limit information?

I'm glad your situation got cleared up! I haven't been UA'd in months and months. I've never heard about United Healthcare requiring monthly UAs. Insurance companies are SO weird and problematic!!

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Fri Aug 22, 2014 6:24 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
My doctor and the therapist working for him as my therapist told me about the one year limitation at my last appointment. He pretty much just pushed my reluctance to taper aside; "How about we go down to 3mgs this month?" Me: "I'm not really ready for that" Dr: ~typing in my file on computer~ "Has notable apprehension about lowering dose." to me: "Okay, so, 3mgs. Don't worry, you'll be fine!" in a trust me, I'm a doctor tone. Basically, they said I needed to taper down a milligram a month so I can be off Suboxone completely by the end of April, which will be a year since I started at that particular facility so I won't be left hanging and they can't be held liable. I've been on Suboxone at 4mgs a day since 2009. The whole thing kind of pisses me off because when I first started going there I was assured that I would be making the decision to come off the medication and that if I get down to the "least affective dose", as my doctor says, and still feel like I really need it then they'd "have no problem keeping me on it for as long as I felt I needed it" in the words of both the therapist and doctor there. I have no problems being a cash-only client as I was at the beginning of my treatment there as they allow reasonable payment plans and the medication isn't too expensive if you use coupons, discount cards and the like. But, my therapist is all; "Oh, it's too much! You want off of it completely as soon as possible! Here; your homework is to write an itemized list of all the accomplishments you've achieved since starting Suboxone and then a letter to Suboxone thanking it and then explaining why you no longer need it's services,". I just have one more problem with the insurance but the pharmacy assured me that my doctor can take care of it and it's that the prior doctor authorization is only good up until the beginning of September, next month. The pharmacist asked me if I'm only supposed to be on this medication for a very short time and when I told her no, I'm suppose to be on it for at least the next six months or longer, she said I needed to clear it up with my doctor. As for the year thing, back in 2009 I was in treatment paid for by Medicaid via the department of social and health services in my city, aka Welfare, and there was a one year limit on treatment and Suboxone but my doctor at the time advocated for me and got them to extend it for a second year. I'm wondering if maybe they are running my info, etc, through plain Medicaid and not through UHC? Which is another topic to bring up at my appointment in two weeks. If you find out any more info, please share. Thank you so much! Also, yes, I thought insurance was suppose to make life easier where healthcare is concerned but every time I've had to deal with them my life has been made insufferably more complicated!

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 5 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