Good Evening all.Today was one heck of a day.
Today I found out that my insurence (as of Jan 2007)will only cover 5 mths worth of Sub! So I asked both my Dr office & the pharmacy...what happens if my Dr plans on keeping me on it long term(as he has suggested)?
I also found out that to pay for it out of poket would be 600.00 a mth!!!
What has me upset is that I recieved no letter whats so ever from either of my insurences.
Now for me the Sub not only helps in my recovery but my Dr is also using it as a form of pain control for my Chrons.
Ill admit...Im really worried(though I have till march)The pain I DO have from the Chrons is pretty severe & Ill admit Im worried without the Sub,Ill end up back on the hard stuff.Ive come so far & I feel so?????Miffed about this.
I live in NY as most know.
I guess I would just like some input on this.As it is I have gone from 24mg down to 8-10mg which I feel very proud of
Any input Id like
Thanks Molly
You should be able to have your doc write up something stating that you are taking the sub to control pain caused by Chrons and not just to detox. This should be enough for the insurance co. to make an exception in your case. I'd start the process right away because it'll take forever for the process to finalize. I'd call the insurance and ask them if there's some kinda process you need to go thru to start this.
Does the sub help the pain, Brina?
Dawnee first hello & thank you for your input.As it stands right now I have till March so hopefully something will work out.My Dr & I are very close.He's been my Dr since I was 17(39 now)so I know he will do what he can
Kat yes as far as my Chrons...Goodness I cannot tell you how much it helps.With me the Chrons is like Labor pains with no break.So therefore its a gift really.Ive worked my butt off to go from 24mg to 8-10 per day & Id like to try to get lower but I really dont want to live like Im in constant labor either ya know.
With my throat it helps somewhat,but when THAT gets bad they give me liquid Lidocaine to gargle,.
Thankfully I have a couple mths & (Im so happy about this)its been about 10 weeks that Ive had my voice back!!! It feels so wonderful.
Ummm my youngest wants some computer time but please I really would like all inputs.
What has me the MOST upset is that I never even recieved a letter telling me of these changes.
I will check back in later & I thank you & whoever else for taking the time to post.
molly
Kat yes as far as my Chrons...Goodness I cannot tell you how much it helps.With me the Chrons is like Labor pains with no break.So therefore its a gift really.Ive worked my butt off to go from 24mg to 8-10 per day & Id like to try to get lower but I really dont want to live like Im in constant labor either ya know.
With my throat it helps somewhat,but when THAT gets bad they give me liquid Lidocaine to gargle,.
Thankfully I have a couple mths & (Im so happy about this)its been about 10 weeks that Ive had my voice back!!! It feels so wonderful.
Ummm my youngest wants some computer time but please I really would like all inputs.
What has me the MOST upset is that I never even recieved a letter telling me of these changes.
I will check back in later & I thank you & whoever else for taking the time to post.
molly
m.J you have an 800 # for your drug plan--Call it and file a protest. I am not sure how your plan is set up but you can appeal.
Do this immediately. Also make a copy of the notice from insurance company and get it to your doctor. Be PERSISTENT and fight for your meds.
Look M.J I only know this. I found myself off of Sub for 3 days and then BOOM MRSA almost died put on morphine AND A BUNCH OF OTHER MEDS AND THEN BOOM THROWN OUT WITH NO SUB IN RESERVE.
Until this drug becomes readily available I suggest to anyone who depends on Sub to "acquire a few extra scripts.
Never ever again will I be in that position EVER where I run out of Sub before I can find a Doctor. Today I have a great situation. tomorrow Who knows. I have found anything can happen and sadly as The FDA makes the suboxone so difficult it forces people to get sick or stockpile the drug..
You read about Summer she ran out--doctor B.S--Now you have an insurance issue.
You have to protect yourself.
You have plenty of time M.J and back to the hard stuff? Thats Bull Spit--no answer as the pills dont work. If they did work for the pain we would all take them.
I have a good friend who I grew up with who has chrons. Its a treatable disease.
Sounds like your doctor is a good one. He/She should be able to help.
--Jeff
Do this immediately. Also make a copy of the notice from insurance company and get it to your doctor. Be PERSISTENT and fight for your meds.
Look M.J I only know this. I found myself off of Sub for 3 days and then BOOM MRSA almost died put on morphine AND A BUNCH OF OTHER MEDS AND THEN BOOM THROWN OUT WITH NO SUB IN RESERVE.
Until this drug becomes readily available I suggest to anyone who depends on Sub to "acquire a few extra scripts.
Never ever again will I be in that position EVER where I run out of Sub before I can find a Doctor. Today I have a great situation. tomorrow Who knows. I have found anything can happen and sadly as The FDA makes the suboxone so difficult it forces people to get sick or stockpile the drug..
You read about Summer she ran out--doctor B.S--Now you have an insurance issue.
You have to protect yourself.
You have plenty of time M.J and back to the hard stuff? Thats Bull Spit--no answer as the pills dont work. If they did work for the pain we would all take them.
I have a good friend who I grew up with who has chrons. Its a treatable disease.
Sounds like your doctor is a good one. He/She should be able to help.
--Jeff
Sabrina, I deal with insurance companies everyday thats what I do at my job. Call your insurance companies and find out if they will cover it after the 5 month period for certain medical conditions. Let me give you an example if a patient comes in with insurance that only covers eye exams every two years but has a medical condition that requires it every one year such as diabeties the insurance company will almost always cover it every year because it is a medical condition and not just something the patient wants to have done every year. If you need help with how to go about this just let me know. Shantel
Jeff, She can't appeal until there is a insurance claim to appeal. She will have to wait to have a claim for sub denied before she can do that. The appeals process with insurance companies is a long process and can take months.She needs to contact her insurance company and see if there are any medical conditions that they might consider paying for longer than 5 months and go from there . Shantel
Sorry to hear that, MJ. I am in fear of the same thing happening to me also.
I don't know what to say except i second shantell's advice; get your doctor to fight for you.
I don't know what to say except i second shantell's advice; get your doctor to fight for you.
Mj,
You need to be proactive now and listen to shantell. Find out WHY they will no longer cover it and what the exceptions are. I don't know about using it for pain management, because I don't think it is approved for pain management. If it's not, then you can most likely forget about trying to go that route. That sucks.
My HMO has a list of drugs they do not pay for and what the alternative drug is, that they will pay for. I am currently switching to a good insurance company that just pays and doesn't make you jump through hoops. However, as I was reading the partial list of drugs, one drug they don't pay for is rozerem. You may know that it is a very effective sleep aid with zero potential for addiction or dependency, and can be used long term. It ranks safer and less toxic than OTC meds for sleep. The alternative drugs listed are ambien, lunseta and ATIVAN! The whole point in taking rozerem is so that you are NOT taking ativan and other addictive substances! This is why HMO's are complete BS. They are dictating patient care, when the doctor should be.
I sincerely hope that your insurance is not like this. I haven't ever taken steps to fight that. I could probably sue them, but don't have the time energy or desire to do so.
Insurance companies frustrate the hell out of me and I intentionally avoid dealing with them whenever possible. But, I suggested that you listen to shantell and ask her for advice because she does medical billing. A person with experience in medical billing would be the best person to advice you. If your doctor has experienced medical billing specialists, great. But beware, certification is not necessary to obtain a medical billing job. Some doctors train people, and you need to make sure whoever is helping you fight this has some experience, preferably with sub situations.
I hope you don't abruptly get cut off like that. But I have to ask, why $600/month? That seems really high for sub at 8-10mg daily. I think my cash price, monthly, for 12mg daily was about $275. That was for 8mg pills and I'm not sure of the exact figure. But even when I was on the same dose with 2mg pills, which are more expensive by the milligram, it was just about $400. You may want to shop around.
You need to be proactive now and listen to shantell. Find out WHY they will no longer cover it and what the exceptions are. I don't know about using it for pain management, because I don't think it is approved for pain management. If it's not, then you can most likely forget about trying to go that route. That sucks.
My HMO has a list of drugs they do not pay for and what the alternative drug is, that they will pay for. I am currently switching to a good insurance company that just pays and doesn't make you jump through hoops. However, as I was reading the partial list of drugs, one drug they don't pay for is rozerem. You may know that it is a very effective sleep aid with zero potential for addiction or dependency, and can be used long term. It ranks safer and less toxic than OTC meds for sleep. The alternative drugs listed are ambien, lunseta and ATIVAN! The whole point in taking rozerem is so that you are NOT taking ativan and other addictive substances! This is why HMO's are complete BS. They are dictating patient care, when the doctor should be.
I sincerely hope that your insurance is not like this. I haven't ever taken steps to fight that. I could probably sue them, but don't have the time energy or desire to do so.
Insurance companies frustrate the hell out of me and I intentionally avoid dealing with them whenever possible. But, I suggested that you listen to shantell and ask her for advice because she does medical billing. A person with experience in medical billing would be the best person to advice you. If your doctor has experienced medical billing specialists, great. But beware, certification is not necessary to obtain a medical billing job. Some doctors train people, and you need to make sure whoever is helping you fight this has some experience, preferably with sub situations.
I hope you don't abruptly get cut off like that. But I have to ask, why $600/month? That seems really high for sub at 8-10mg daily. I think my cash price, monthly, for 12mg daily was about $275. That was for 8mg pills and I'm not sure of the exact figure. But even when I was on the same dose with 2mg pills, which are more expensive by the milligram, it was just about $400. You may want to shop around.
To all I only have but a minute because its kitty day but I did want to say ....how lucky I truley am.See my Dr office has already started to work on this for me as far as appeals & having my Dr tell them my medical condition.
Does this mean Ill leave it in thier hands totally?Heck no.Beings I once again have my voice back I will take an active role in this
As I said I do have till March..but as we all know...time does move fast so Ill waste no time.
I owe all of you a big thanks just for taking the time to post & also owe emails(Jeff Giants etc)
I should be home by 1 today so Ill be back than
Thankl you all again just for your care & concern & meek....well Im not
Love molly
Does this mean Ill leave it in thier hands totally?Heck no.Beings I once again have my voice back I will take an active role in this
As I said I do have till March..but as we all know...time does move fast so Ill waste no time.
I owe all of you a big thanks just for taking the time to post & also owe emails(Jeff Giants etc)
I should be home by 1 today so Ill be back than
Thankl you all again just for your care & concern & meek....well Im not
Love molly
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