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WannaBnormal · 09-07-2003, 10:02 AM

I dont know what is going to happen at my appointment tomorrow, but here is what went down about my fessing up on Friday.

I had left a message for the "med nurse" (gotta go thru her before a doc will return a phone call. She calls you 1st and finds out what the prob is then discusses it with the docs and they decide who will deal with it from there) and she called back. I told her what I did ~ honest and open. She asked a few question, very clinical, and said that since it was Friday and everyone was gone for the weekend (they only work a half day on Fridays) it could wait until my appointment on Monday morning.

So I dont know if they will continue to treat me with Suboxone after my little ignorant trip ~ I'll know when I see them Monday http://www.healthboards.com/ubb/confused.gif

As far as the insurance issue ~ we got it worked out and you wont believe it! We had a lapse in coverage of 62 days and the limit is 63 http://www.healthboards.com/ubb/dance.gif DH and I took turns reading the HIPAA stuff online and he did some digging of his own at the HR department where he works and we are just making it under the wire. This new insurance company cant deny the claims based on "pre-exsisting condition"!!!!! We've got all the documentation we need ~ certificate of credible coverage and a letter from the HR dept stating when his waiting period begain, so its all good http://www.healthboards.com/ubb/t_up.gif What a load off!

So I thank you all again for your help, advice, and support. If anyone is interested I'll post what happens at Monday's appointment.

LA

BlueSkies · 09-07-2003, 12:56 PM

Good luck tomorrow. I don't know anything about subexone, but I think I read that you took a whole bunch trying to get high, but didn't?? Hopefully, since you were honest, they will give you more.

Hopefortoday · 09-07-2003, 04:59 PM

WannaBe . . . props for being honest with your doctor's office and that's great news about your insurance. Our insurance didn't cover my husband's Suboxone at first, but now it does.

Good luck with your appointment and keep us posted!

CaptainJack76 · 09-07-2003, 09:00 PM

Hey Hope? How come it wouldn't cover it at first and now it does? Just wondering, because mine won't cover it. They say they are going to "review" the medication in November and decide if suboxone will be covered. But did you do something like write them a letter? I'd just like to know how you got the insurance to pay. Thanks Hope - Captain Jack

H2OEng · 09-08-2003, 06:41 AM

Stupid me, I replied to the other post. Glad to hear you got everything covered under insurance. I know that's a major load off your family.

Capt, you can get what's called a "Letter of Medical Necessity" from your doctor. Tell your doctor what's up with the denial and they will know exactly what the letter is and what it should say. Talk to your insurance company about their appeal process and do just that. Appeal the denial, submit the Letter of Medical Necessity for the review process. No guarantee it will get approved but you never know. I've managed to get things covered on my wife that were originally denied by doing just this.

You should also keep up with what drugs that the insurance company will approve, these change once or twice a year in an internal review for new meds on the market (also for new doctors included in the plan).

Like I said in my other post, just need to know how to play THEIR game to win!

Hopefortoday · 09-08-2003, 08:04 AM

Captain . . . I'm really not sure why. I'll have to ask my husband. I know he changed pharmacies . . . don't know if that had anything to do with it or not.

CaptainJack76 · 09-08-2003, 10:15 PM

Thanks Hope. Any info would be great. Keep me posted.

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