Cant get a straight answer from anyone!

This is litterally my first time ever asking for advice on a forum so pardon the scrambled mess that its about to be.
I came across this site searching for anything that would point me in the right direction as to why my state has yet to approve/deny my doctors prior approval request for suboxone, which i have been on for 5 years this past October 20. Now the confusing part. I started treatment in another state 5 yrs ago and went from losing everything and everyone to where i am today, married with 3 yr old (mine) and 9 yr old (his) daughters(ours). 2 yrs after beginning MAT I got married and moved here but because my family is still in MD where i started treatment, i stayed with the same doctor so i could visit my family once a month. Everyone thinks im crazy for traveling 7 hrs up and back every month but its a decision i made when my husband asked me to marry him and he lived here, not Md. (We met yrs ago and he was living in Md at that time, Fate brought us back together 10yrs later) Anyway, I havent had any issues with getting an approval from medicaid until this past PA. From what ive been able to find out is nothing in the policies or even the criteria has changed except for continuance attach a treatment plan and my doctor has a new office manager doing the PA's. Thats all that has changed. So before knowing a treatment plan had to be attached my doctors office manager sent over the normal PA form n medicaid sent a message back stating it was incomplete. So my docs office called and asked what they needed, filled out some other papers, sent it over and they said it should be good to go now. Well it wasnt, pharmacy said PA still needed, and message to my doctor stating they now need a treatment plan. They sent over a treatment plan. All this over this month of november. Well still no answer. No denial no incomplete no nothing. I called the PA line and they have nothing of the sort in the system soi call my doctor for the 25th time and at this time we have both exhausted every option so they sent the entire packet of papers over at one time thinking maybe it went to different people when it was sent in pieces as they asked for it and still nothing from medicaid.. the last thing they are willing to try is the doctor himself calling personally. I dont know why he didnt in the first place. But as all this is going on i have had to spendmoney i dont have just to stay afloat. I dont know what else we can do and i am at the end of my rope. I thought i was done with all the doing anything and everything to get a few dollars to not feel like crap and the nonstop worry. My worry is will it ever get approved so i can keep on with the life ive made for myself over the past 5 yrs that i would not have, had i not got into treatment when i did and i most likely would not be here alive and breathing to even type this. Any advice on what to do or say, or who to call. Another thing that upsets me is christmas is right around the corner and ive had to spend well over $500 this month when this was finally going to be a better christmas for the kids and i dont even know if i will get it back or not. Did i mentionall the info regarding PA in NC is on this site, medicaidpbm .com if anyone is willing to look and see if i missed somthing as to why im not getting any answers.

Hi Carolinamommy,
First off let me say that I don't think your crazy at all. You do what you feel you have to do.
I want to sort out a few things. You live in NC but your provider is in MD. You are currently on NC Medicaid?
Let me give you an example of what I mean. I live in the state of Vermont. If I were on Vermont Medicaid, I would have to have a provider in Vermont in order to fill my prescription.
That is why I ask what state of medicaid you have. I just went to the site you listed and see that it is NC medicaid that you have.

It could be that the new office manager sent the paperwork to the wrong state of medicaid if you have medicaid from your own state. Ask her where she sent it. That may be why they don't have a record of it. It is worth checking out. If she says she did send it to the right office of medicaid, ask her for the phone number of the office. That way you can see for yourself that she did send it in to the right one.

Your provider can call medicaid for the PA. That is the way it used to be. The provider would call and you would have the PA within hours instead of days. Times have changed and now everything has to be done either by mail or fax.

Welcome to the forum, we are happy to have you here with us. Please don't hesitate to ask questions, that is why we are here. To help and support.
We have some really great members here and I'm sure they will be along at some point to say hello and give you some feedback as well.
Take care and keep us posted on how it goes.
Dee

Hello CarolinaMommy,

welcome to our forum and congrats on your years of living addiction free !
You accomplished a lot and you should be proud.

Unfortunately, I'm a bit new to Suboxone and Insurance in general but I would
follow Dee's advice, she knows alot of ins and outs of the treatment we are in.

I wish you luck and keep us posted !

I do want to add to my post above, please, please don't give up on this. Keep searching until you find your answers. If it would help I would be happy to make a call to your insurance company and see what I can find out for you. You can send me a pm to let me know.

I know that spending money on medication gets way expensive and especially at Christmas it can be really depressing. Have you been to the Suboxone site? They do have a coupon there that you can print out to use and it will save you $50 towards your medication. It isn't much I know but it will help. Here is that link. All you have to do is print out the card. It expires at the end of December and can only be used once during the month so use it while you can. There are some other discount cards that you can also use if you need them. I have them posted in another area of the forum and will post the link at the bottom of this post.
I hope you are doing okay, let us hear from you when you are able. We do care.
Dee


http://www.superrxcard.com/

Hope i cant get this to post. I been trying to respond but when i ht send, nothing happens.
OK so thank you for the replies. I really appreciate it. Thank you for the congrats, i dont hear that as much these days even though its i lifelong struggle for me to not turn to my ex best friends (D'sOC). I was a prescription and street opy user. Its amazing what a few little words like that can do for my self esteem.
Well i called my doctors for the 30th time today (bless there hearts) and was told my doctor is calling personally because this has gone to far without any reason why. Im in NC and theyre in MDwhich shouldnt make a difference as long as he is able to write the prescription and treat me according to federal guidelines. That website says nothing of the sort, him being out of state voids coverage. Seems to me and my Docs office manager that they are being difficult in hopes i would just forget about it. They got a fax yesterday 6:25 statin his dea# was needed though its on 20 other faxes.sounds weird to me. But your right its chriistmas and having to spend this crazy amount of money to stay normal is depressing. I think if i had a sure fire way to get it back since the pharmacy only refunds 7 days back, it make me feel better since i could make up for christmas later but i wouldnt even know who to call to find out how to get it back. And im still on the tablets until they run out of them, my insurance still has them on the preferred drug list, PDL, too. Im glad i found this site, ill be back often even if i dont post anything. Wish me luck, and ill let ya'll know what happens after i find out my self.

EDIT: Hope i can get this to post.

Oh and maybe i should add that my medicaid doesnt pay for my visit. They wouldnt since he is out of state and he dont take ins anyway cuz from medicaid, providers get squat. Medicaid only pays like half of what regular insurance would pay. Thats why its hard to find doctors in general to accept medicaid, in any state. If that makes sense.

Hello Carolina Mommy! I just read your post and was wondering if you ever got all that mess figured out! I joined the forum a bit before the time that you posted. Surprised I did not see this sooner!
Anyways I'll tell you a bit about myself. My name is Jasmine. I'm 20 years old. I have a son who's almost 3 and a step daughter who is almost 2. Their names are Cooper and Zoey. I am engaged to my fiancé Casey. We've been together for almost 4 years now. (I know you're wondering how we've been together for 4 years and he has a daughter that is 2.) We had broken up for a while but something brought us back together. And we've been happily together ever since.

I am taking 8mg suboxone once a day. Which is great for me because a short time ago I was at 24mg, I always stressed out because it is such a high dose and it really depressed me. The dose was actually dropped down so low by an accident it started out and I kinda just stuck with it, and I felt fine with no withdrawal or cravings. It's actually a funny story.

My fiancé and I left the house right after I took my firs dose of sub, and I didn't bring anymore with me. We went to run some errands and work on our new house and by the time I realized I had missed my thee two doses of suboxone it was already 10:00 at night and 2 hours passed my last missed dose. I discussed what had happened with Blue Eyes here on the forum, and told her my plan of staying at 8 mg and IF I ha any withdrawal symptoms I would raise my dose 1mg until I found my lowest comfortable dose.

Turns out my lowest comfortable dose is 8mg. That is until I am ready to drop another mg. But I don't think tha is gonna happe. For a while. I'd like to just stick at y 8mg and continue on learning te tools I need for recovery!

Whew that's enough about me! That's kinda my thing lol I ramble on and on here on the forum lol.

I would really love to hear your story about how suboxone saved/changed your life and how you solved the insurance problem you were having. If you like to share your story you can post it under the "Suboxone Stories" thread. I have posted my story there if you're interested in reading my whole story. And also moderator Blue Eyes also shared her story! It's a beautiful story. You should read it if you get a chance. I am sure yours is a beautiful story too! And I'd love to hear it!

Let me know how you're doing!

Have a blessed day! Much love!


- Jasmine

Oh wow, I can't believe it's been nearly 2 months since I put any news about the PA issue!
For anyone actually interested in what, when and how, everything came out in the end, I feel the utmost need to post the info for anyones elses future issues with medicaid/medical assistance in general. It is only going to get more difficult for addicts like myself so if this helps atleast 1, it was well worth the time. (My typing is faster than my phone is putting them on here)
My only real tried and proved advice to anyone in this situation or the similar would be, DO NOT GIVE UP, CALL EVERYDAY, AND BE PERSISTANT! Find any phone number and call, someone will point you in the right direction.
The update for me is after 35 long drawn out days of calling and emailing, they finally gave my doctor the approval and when i went to get the rest of my prescription, I think we all did the happy da.nce and had tremendous weight lifted. My pharmacy is family and they stood by me every step of the way without one huff or puff. Thank you Eden Drug! And for a speedy and complete refund in 4 days only because of Sat. & Sun. Or it probably woud of been a just a day n a half.
Anyway, I never did get the reason why it took so long but I'm almost positive it was a scare tactic in hopes of me "giving up" that didnt work at all!
Note:This all started right before huricane sandy hit in October and didnt get an answer until December.

Hello CarolinaMommy!

My name is Jasmine and of course we want to know how things went! No matter how long it has been!
Let me tell you a bit a out myself. I am a 20 year old stay at home mom. I have a son Cooper and a step daughter Zoey. I was in active addiction for over 5 years! It started when I was 14. It was just Vicodin. Eventually my tolerance went up and I moved up to stronger stuff. It was the fentanyl patches I was really bad on. That's when I decided enough was enough and it was time to save my life! I have been on Suboxone for almost 6 months now! And it truely saved my life!

Wow I am having problems with my prior authorization going through as well! I was approved for 6 months and it expired as I was told I had a year, so I was supposed to be approved for another 6 months, it is now day 4 and still nothing! I really hope it doesn't take months like it did for you! I'm sorry you had to go through that. But I really can't afford to buy ANY out of pocket at all! So hopefully this goes through before I run out!

Thank you for sharing! And letting us know the out come! Again I'm sorry you had to go through all of that! And I am happy that you never gave up!!

Hey Jasmine,
Excuse me for saying this but i felt like i was lookin at my own picture looking at your image. Well, before I got to comfortable with my husband and I wish i wouldnt have because I dont know how he looks at me everyday when I dont like how I look right now. Lol I guess the whole love is blind saying is true.
Enough about that. I dont know your exact situation, like what state uou live etc.. but im do sorry your stuck waiting on a PA wjen thete should be 6 mos left on it. Thays what i meant by its only going yo get worse, especially for folks like me who depend on Medicaid. Theres numerous possibilities for why, like new policys regarding time limits that we rarely get informed about and if we do, its not in lamens terms so we dont understand most of it.
When my PA was due again, I was prepared but not for as long as it took so I did so much "research" that i could run nc medicaid but my point is the system is so screwed up that it could be a minor mistake like a typo or could be big like policy change, or budget cuts that cut us out. Most dont understand addiction and definitely DO NOT realize the possible consequences of having to wait for a PA. In my case I had my 3 yr old daughter keeping me straight and my husband, who still doesnt get the whole purpose of suboxone but he is not an addict so I dont expect him to. Besides him not understanding why i need to take suboxone everyday, he is there for me and was the main provider for me to be able to pay out of pocket for 35 days. I had a rough time because it was just not possible to pay for my usual daily dose but I made it throughwithout having any major setbacks or WD's.
Ill keep you in my prayers and hope that your PA goes through sooner then later. Im sorry i just rambled and maybe one day I wikl be able to tell my story but the way my phone is typing on this site is just soooo slooooe to register what i write that it takes forever to type one sentence. Im going to try and put some pictures in my profile so you can see what i meant in the beginning. Good luck to you and hope you get good news soon!! 6 months is an amazing accomplishment, congrats!

They told me today that it should go through by tomorrow so I'm hoping it does! I prayed this process would go smoothly! But if it doesn't go through tomorrow then I will be going without the next day because tomorrow is my last dose that I have left.

You are very lucky to have your husband there to help you out! My fiancé is here to help me out and he's buy them for me if he could, but we are going through a rough patch and are having money problems. Last week we actually had to let my cell get shut off for a few days between paychecks because we just couldn't pay it. We just rented a new house and it is starting to look like we may not be able to afford it! We moved in so quick because we had to get out of the last place so quickly (our landlord went to prison he was doing something illegal with his renting) anyways we jumped into this place knowing it was a bit out of our price range, but it was all we could find at such short notice. We are now lookin for something more affordable for us, but still that doesn't change the fact that we can't pay for my suboxone. See now I'm rambling. That's what I do though. I post all over the forum rambling on and on lol.

I too rely on Medicaid for my suboxone and I hae had a problem filling my script every time since I started taking suboxone 6 months ago! Always something small and stupid that could have been avoided but all mistakes that Medicaid had made. Sometimes it seems like they did it on purpose!
I really hope they get this PA to go through for me ASAP! I am on pins and needles. I am so worried about it I can't think about anything else!

Suboxone really helped me get my life back! It really did save my life. At the end of active addiction my fiancé was ready to leave me and I was about to lose my son. Who was two and a half at the time.
With the help of suboxone I have managed to save my relationship, take control of my life and get my ducks in a row so that I wouldn't lose my son!
If the is doesn't go through I don't know what I'd do. I know I am not ready to get off the sub yet. I mean I have lowered my dose from 24mg to 8mg, but still 8mg to nothing is a big drop ad I don't want to go through those horrid withdrawals!
If it takes a week or weeks to go through I think the only thing that would help me get through it would be my fiancé and my son! My fiancé is very supportive in my recovery and my son relies on me for everything. Well he's 3 almost everything. He's actually pretty independent. He just needs me to cook for him and fix his plate lol. He pretty much does everything else on his own.
He's a typical boy! He loves cars and video games. He would sit there and play video games all day if you let him! Lol.

Sorry I am getting off topic and rambling. Just thought I'd give you some info about myself and my family.

Anyways the point of this post was to say that I am so worried the pa won't go through. And if it doesn't we cannot pay cash for any of my meds at all! And I am just so worried about it I can't think straight!

So I called my doc office today, they said they still haven't received a fax saying my PA went through. Pharmacy says it still comes back requiring a PA and Medicaid says they are waiting for some papersfrom my doctors office, papers they say they have already sent in. I am really starting to lost hope in this hung going through any time soon. This is terrible!

CarolinaMommy,
Glad to hear that everything finally went through for you. I hate hearing how long it took though, there is simply no excuse for it. Your persistence paid of for you in the long run and that is usually what it takes. Persistence.

Jasmine, I had no idea you were waiting on a pa as well. I thought that part was taken care of.
*big huge huff and puff with steam rolling out of Dee's ears at the thought of medicaid*

When are you due to see your provider again? Can you go into the office and have them call medicaid while you are there?
When the doctor sends a fax into medicaid he should have gotten a receipt back when the fax was transmitted. Ask them if they have it. If they do, call medicaid and tell them. Give them the date etc.
Call, Call and call again.

Life is not a giant coffee break for those of us who need our meds.

Jasmine,
Question for you. When you were told you needed a new PA was that when you were switched over to the strips from the tablets? If so, that may be why you need the new PA, anytime you switch forms of medication it makes the old PA null and void.
Hopefully you will get a full year of PA out of it so that you won't have to worry about being cut off sooner than later.

Hey Jas,
I was going to suggest the same thing Dee did . GO to your doctors office and find out
if they have proof that the fax went through (Transmition receipt) and then have them
call while you are there.
It's crazy that this takes so long.

CarolinaMommy,
It's nice to hear from you !
I'm glad your insurance issues were straightened out.
Stay in touch ok ???


(((HUGS))))

Blue

My PA finally went through and Friday jus in time! It only took them a week!
My old PA was terminated because wen I first started suboxone I was going to a different provider Recovery Pathways. They're the ones who initially set up my PA. When I switched providers my PA was still effective and I switched like 3-4 months ago. Recovery pathways called and cancelled te PA that try had set up! So I needed a new one through my new doctor. Even though I've filled my script 3-4 times with the PA the recovery pat was set up! I found out that once you have a PA for suboxone you could change doctors 5 times if ou wanted and te PA would still be good. Recovery pathways just decided to cancel mine. And I have no idea why!

I was almost denied for my new PA though because Medicaid thought I was kicked out of Recovery Pathways for drug use or not following the program. But I just left because I didn't like the place and wanted a provider and therapist I was comfortable with. Anyways in order to get a new PA Medicaid needed proof that I had even going to EDM for a few months and they wanted drug tests proving that I was taking suboxone and I wasn't using my DOC. Thank god my doc office is great and they called Medicaid and explained to them why Recovery Pathways canceled my PA. (The secretary at EDM called Recovery Pathways to find out why and they said it was standard procedure for anyone who leaves the practice. I'm just wondering why they waited 3 moths!!)
Anyways I am blessed to have such a wonderful doctor and all the other people at the office who made sure that everything that could be done to make it go faster was done. I must hae called them 20 times and went in at least 4 times to get proof te faxes we sent in! They spent hours on the phone with Magellin (Magellin is te part of Medicaid that deals with all suboxone and PAs) and lots of time on the phone with the review board. (The people who review everything and decide whether or not to prove or deny somebody for the PA)
I also am thankful for my pharmacy! They were very nice and didn't get upset or frustrated no matter how many times I called or went in asking them to run it through again to check and see if it went through!

When I finally got the phone call today from EDM saying my PA was approved I went straight to the pharmacy. When it was approved at the pharmacy they all cheered and were so happy for me!

Anyways I just wanted to let you guys know that it finally went through! And explain why I needed a new PA since Dee had asked!