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PostPosted: Sun Sep 10, 2017 3:06 pm 
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Envision RX has unlisted suboxone from their "covered meds" list and hit me with a prior auth on the Labor Day weekend. My doctor submitted the prior auth form the following Tuesday and then contacted me Wed to say that the insurance denied the prior auth. The reason?! They claim that my doctor is treating more than 275 patients for opiate dependance although they haven't proven in any way that they have proof of this. They claim that they also denied my appeal and that they "Absoluely will not" approve a script from this office or doctor. My doctor said that he has NEVER heard of this basis for a denial of medication coverage and that he is NOT treating more than the 275 patient max. I've done all that i can do and i guess i need to find a new doctor.

Does anybody have experience with this? Advice? Etc? Thank you!


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PostPosted: Sun Sep 10, 2017 3:51 pm 
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I have never heard of this and it sounds like complete bullshit!! It makes me so mad that you have to prove the negative, or in other words, you have to prove that your doctor doesn't have over 275 addiction patients, instead of them having to prove that he does! That is infuriating!

Have you tried seeing if they will cover another brand of buprenorphine? It would make no logical sense it they did, but obviously insurance companies are not about logic.

I'm so sorry that you will have to find a new doctor to stay on your medication. Are you on a high amount? Can you do a rapid taper to 10mg or even 8mg so that you might be able to pay for your script without insurance for now? GoodRX can give you a decent discount sometimes.

https://www.goodrx.com/suboxone-film

Your doctor's office might also have a coupon given to them by the manufacturer

https://i.pinimg.com/736x/19/07/4b/1907 ... dpress.jpg

It sucks that you are going through this and I wish I could help. You're not from Colorado are you?

Amy

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PostPosted: Sun Sep 10, 2017 10:15 pm 
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Thank you for your reply.

Thankfully i tapered on my own down to 4 mg and stockpiled the other half of my dosage for a while JUST IN CASE the SHTF and it just did hit the fan a week ago. I am in Michigan, i am filing a formal complaint with the state's insurance board, filing another written appeal (requesting documents as well about their internal audit of patient numbers), and ready to have my attorney write a letter to Envision RX (under Aetna).

I also have two appointments scheduled this week for new doctors even closer to me than my previous. The second appt later in the week is just in case i have an issue with the first office through my insurance as well.

If Envision RX thinks I'm going to die quietly in a dark corner they are sorely mistaken. They have picked on the wrong person in their attempts to shave costs. If they continue this flagrant garbage I will happily pay my attorney to open a line of communication with Envision RX


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PostPosted: Mon Sep 11, 2017 12:15 am 
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I LOVE it! You go! I would love to hear about it every step of the way!

Your post fills me with hope! And I feel the exact same way when my insurance company messes with me or my medication. We need more people exactly like you.

You know, with the opioid epidemic affecting such a variety of people, thank goodness that includes people who are willing to stand up for themselves and others. We don't need to sit in a corner and be ashamed. What we need to do is be heard.

Thank you for posting!!

Amy

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PostPosted: Mon Sep 11, 2017 12:10 pm 
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For one, I suggest you go to their website and down at the bottom you'll see the site map. Look for the CEO's name or try to call and or do a search to find out the name and address. Then physically write a letter detailing your problem nice and neat, then mail it. You'd be surprised what a hand typed letter does for a patient. Don't do the email route. They just delete those or ignore them because they probably get thousands per day.

Good luck on your fight. I agree that it is total bull that they pulled the carpet out from under you. Do not go quietly in the night!

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PostPosted: Mon Sep 11, 2017 1:29 pm 
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Consider filing with the State Attorney General as well.
Would your doctor be willing to forward your information to the State Medical Association? AMA but at the state level. They do patient advocacy at the legislation and with various boards.
For an insurance to come up with that as their rationale is complete and utter BS. I don't know how they would have access to it. I can see my list of patients on the PMP (state controlled substance site) but others are not supposed to be able too.


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PostPosted: Mon Sep 11, 2017 10:42 pm 
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Also check this link! I just talked about a new innovative treatment idea in Michigan:

innovative-treatment-plan-michigan-t13823.html

Amy

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