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Doctor overcharging for Suboxone Treatment?
An_227038 posted:
So my friend has insurance that covers this doc in network, but the doc says for suboxone treatment, the co-pay does not apply, instead he wants $250 up front, then 125 each addtl visit. The insurance did cover the meds.
Anyone else have this problem? Have any advice?
Taximan283 responded:
It's interesting that you should come along right now.(I hope someone else here sees this post) As far as I know, no Sub doc takes any kind of insurance for what we'll call, the office visit. They all take only cash. (what I mean by cash is you have to pay the entire visit out of pocket. Some take credit cards, and some take personal checks once they know you) Now I may be wrong about this, because I haven't had to go shopping for a Sub doc for 5 years. Maybe things have changed. But 5 years ago no Sub doc took insurance. However, thankfully the insurance covers the pills, because they are very expensive.

But now tell me something. Don't you think it's odd that Sub docs don't take insurance? What's more, only docs licensed to give out Sub can prescribe it. No other doc can. I find that strange. Usually once a doc has a license to practice medicine he can prescribe any drug there is. But not with Sub. I wonder why this is? Did you know that Sub docs are also limited to no more than 30 (or 35) patients at one time? Now that's really strange. Since when does the government tell docs how many patients they can have? Maybe the government should tell docs how many patients they can have, and that way you wouldn't have to wait in waiting rooms for up to 3 hours to see certain docs. But the government doesn't do this with anything other than Sub. What's more, some Sub docs try to sell you the pills themselves. I haven't heard if that happening in 5 years, but 5 years ago I heard of it too often. Docs aren't supposed to sell you pills. They're supposed to give you scripts and you go to a pharmacy to get them. Why are there all these strange and different things going on when it comes to Sub? I think all this is very strange.

Well, you're new to this board and I said all that to get you thinking.

As for your question, it's not a problem. It's the way things work with Sub. I'd also say your doc is about average in what he's charging you. I've heard of some docs who charge much more, and 1 who charges much less. How much they charge is up to them, so it might be a good idea to call a few others and ask their prices. It does vary.
Louise_WebMD_Staff responded:
Call the insurance company and get the details straight from them on if/when/who they can see for treatment if anyone.
cinn777 replied to Taximan283's response:
Taximan283 replied to cinn777's response:

The link I'm giving you will take you to a web site that can help you find a Sub doc. But you better think long and hard before going on Sub. You might be better off with Methadone. It's a much better pain killer and it doesn't permanently alter your brain. I suggest you read everything I have written on this board about Sub. I also invite you to email me. You can get my email addy by clicking on my name. It's in my profile. You have your information scattered over so many posts that I don't know where to answer you. I can see you have a serious problem, and I believe the medical profession is doing you wrong. Maybe I can help you, but I'm not sure. But it would be easier in email.

Here's the link:
Outpatienttreatme responded:
That is B.S. insurance Companies do allow billing for Suboxone from intake 1st Appt & each follow up appt. office simply would use code 99203 and diagnosis 305.50 1st visit and 98213-99216 and diagnosis 304.00 for follow up visits. To be sure office could easily call your insurance for Pre-Certification of treatment visits & once approved, office knows they will get paid. Most insurance pays a good rate to office (similar to what you are being charged) for the patients visits. If they won't do that then you have a right (written rule) to ask them to complete their portion of a claim (billing form) either Form 1500 or print out blank claims direct from your insurance co website, and have them keep supply in your chart or bring one to each visit. Ask them to fill in & sign their part if form then you fill in yoUr info. Make sure you sign the line that reads "assignment of benefits to patient" (not doctor or facility). This means any reimbursement (avg. 40-60%) of your visit cost is reimbursed back TO YOU if you paid office in full each visit. Your usually can do this retroactive 90 days too. In beginning insurance did not pay dr claims against suboxone treatment, but they do now for a long time. Call Your insurance to get your visits pre-certified Using procedure & diagnosis codes above 1st if authorized to go out of network and they approve your request you will get most if your visit fee reimbursed ea time as fir med not being covered, it Only means not on your insurance "Formulary" & needs Prior-Authorizatiob call member services tell them you need a prior auth request form faxes to your Dr office under your name for med subixone in dose & maximum qty you expect to get rx'd dr office must submit this request takes less than 5 min via fac or can do over telehone and usually if correct procedure abd diagnosis codes used (see above if apply to you-probably do) also insurance more readily approves suboxone cost coverage if rx'd the Film vs Tablet they will ok covering cost of suboxone film (msybe tab too) ususlly for 1 year (than a renewal) & max30-day Qty of #90. It is a simple procedure and dr office should do for you if they want you ad a patient make sure prior-auth for coverage of med cost is done for actual med, dose & frequency ((request #1) & ALSO for approval request for 30-day QTY (Request #2) both can be requested & approved during same call or fax of Prior-Auth Request to insurance co. Good luck. Send MSG, if you have any ?'s
ljude38 replied to Outpatienttreatme's response:
Lets keep in mind that suboxone is not really the kind of medication that one wants to stay on for an extended period of time. In small doses its an opiate agonist and in large doses its an opiate antagonist and lets not forget can also be highly addictive and terrible to withdraw from. The last thing one wants to do is get addicted to suboxone. I work in a detoxification facility and have seen the many perils suboxone addiction has caused. I am also confident detoxification and maintaining an opiate free lifestyle is possible. I have seen the proof for myself. There are many ways to detox. I am an addiction specialist and have been working with the rapid detoxification process for years and find that its the only way to go although it isnt for everyone. I wish you well and hope you find what you are looking for.

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