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Unread 06-08-2009, 01:23 AM   #1
csdmommy
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Default Help for ANY & ALL Insurance ?'s

As some of you already know, I know quite a bit about the in's and out's of medical insurance. I am a certified medical coder and insurance biller. I am using this knowledge to help anyone in this forum, as I see that there is a need for this type of assistance. Post any questions you may have and if I don't have any answer for you, then I'm sure someone else can help. I also have contacts at many insurance companies, as well as most of the state and federal programs. These people have always helped me out when I had a question related to my past work in the field and I can glean information from them to help you guys out.

So........any insurance questions are fair game........ask away!!!!
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Unread 06-08-2009, 08:02 AM   #2
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Hi, im dawnny, well i have Americhoice Nj family care, so far everybody they give me for doctors , i call them and they dont take the insurance anymore. americhoice was suppose to do a dsearch for me but never did. right now im in the middle of renewing, i put a diffrent insurance co which is horizon blue cross blue shield, i found out my sub docter takes it, and my daughters docter, so maybe ill get somewhere. when i called for a psychiastrist that didnt have any, and 1 denied taking me on, which i think is terrible. thats under americhoice meantime i pay my sub docter 125.00 every visit, im lucky they pay for the sub. n i hope i dont have bad luck with horizon. i have medicaid so its really hard finding anybody in my area, everybody pretty much has money around here, sparta,new jersey. but i dont.well if you have any suggestions for me i would appreciate it. thank you
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Unread 06-08-2009, 08:55 AM   #3
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Hi cdsmommy, thank you so much for offering your expertise! That's so nice of you.

dawnny, have you checked to see if you can submit the doctor's receipts to your insurance company on your own? Some insurers have the correct forms on their website.

Nancy
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Unread 06-08-2009, 11:01 AM   #4
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CDS, I don't have any questions right now, but, I too would like to thank you. This is something which many have questions and concerns about and it can really play a large role in their ability to find and stay in treatment.

Mike
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Unread 06-08-2009, 02:13 PM   #5
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Hi cdsmommy. I have "public insurance" and none of there providers are licensed to prescribe suboxone, so I had to private pay. Then they tell me that since he isn't one of there providers- they wont validate any Rx from him. They actually have a note in there system stating any Rx from this certain doc are automatically denied....I don't know what to do.... any suggestions?
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Unread 06-09-2009, 10:25 PM   #6
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nancy, i gona check that out, thanks
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Unread 06-10-2009, 06:33 AM   #7
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Hello cdsmommy

I would also like to thank you for your offer to help with questions
regarding insurance issues.

Thank You............Tony
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Unread 06-11-2009, 05:04 AM   #8
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Dear cdsmommy

Thanks for your offer of assistance.
Just recently I've been trying to contact medicare, but can't get through to make an appointment for them to call me back, as I've done in the past for phone appts.

Do you know if they cover the appointments?

Also when I go for my appointments I get a stamped hand written receipy, saying just the amount paid and for how many weeks. For example, May 4, 2009 Paid !00.00 2 weeks, and then signed by the office mgr.



My previous MD would give me on his letterhead, say for 2008 each month the amount I paid with no diagnosis. I needed this for the housing authority. This md would sign this. If medicare does cover, would this be enough for them?

Thanks,

Steve
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Unread 06-11-2009, 10:22 PM   #9
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Sorry I haven't been around guys, but the kiddos had swimming lessons this week. They have Fridays off, so I'm going to spend tonight and tomorrow working on everyone's questions from this thread. There are a couple that I'm making some calls on, so it will be tomorrow afternoon before I can give answers to those questions. I'm getting there, though! I appreciate the thanks from you guys.....like I said, if there is knowledge that I have that I can use to help someone else, I am more than happy to share it.
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Unread 06-11-2009, 10:30 PM   #10
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dawnny: Is Americhoice your Medicaid HMO? I know it is in some states. I have a few suggestions for retropayment (getting your money back that you've already paid), but I need to know if Americhoice is your Medicaid. Thank you!
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Unread 06-11-2009, 10:38 PM   #11
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csdmommy, i have an amerchoice card and a medicaid card, i just changed my hmo to health net, but it didnt go into effect yet. i live in new jersey, alls i know is i have 2 cards, 1 medicaid and 1 i pick for my hmo. any help would be greatly appreciated. thanks dawnny
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Unread 06-11-2009, 10:52 PM   #12
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hopeful27: You said that you have a "public insurance". What kind? Is it Medicaid, a city or county assistance plan or a type of Medicare/Medicaid HMO? After I know, I have a couple more questions about the physician locator for the plan and some questions about this particular doctor. Something doesn't seem right about him/her. I just don't want it to affect you in the form of you having to pay out money that you neccesarily shouldn't have to. I may need to get your E-mail so you can send me the doctor's name. I can do a little research to find out if there is anything going on with their licensing or any censures/lawsuits in progress.
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Unread 06-11-2009, 10:55 PM   #13
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dawnny: Great! Ok, Americhoice has been your Medicaid HMO. Give me just a little while. I'm checking into that HMO for your state. Are you going to be online for a while?
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Unread 06-11-2009, 11:03 PM   #14
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Steve (chnmnnY): I'm working on yours, too. What 1-800 number are you calling for customer service at Medicare?
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Unread 06-12-2009, 12:11 AM   #15
marn71
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Thumbs up peace of mind

I think that good news came my way today!!my doc charges 350.00 every visit,and it was really getting to where I couldnt afford it anymore,started to get very concerned.So today I got brave and called his receptionist,and they both know how important this is to me and my family,so we made an agreement that if I dont miss any appointments,that he will take a payment each month,it has to be a decent amount,but he agreed that would be fair.with 350.00 every visit which is every third week and 600.00 for 90 pills there is no way i could pull it off,so I also got a second job,and will use that money just for my doctor visits,and perscription,rite-aid also told me you can pick up what you can afford at the time,so if you can only afford two weeks worth of meds,pharmacy holds on to the rest,they stay in your account..So I am very excited to see him tomorrow,he is expensive,but to me this has become top of my list.
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Unread 06-12-2009, 12:24 AM   #16
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marn71: I'm glad that you have a team that is concerned with your recovery and health. If only more professionals would help others out...................

Good luck!

-CSD
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Unread 06-12-2009, 12:31 AM   #17
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marn17:

Do you have an insurance plan? If you don't, based on your income and expenses, you could potentially receive assistance to help pay for your healthcare needs (not just Suboxone treatment, but other services, including medical, dental, vision and pharmacy). You need to apply and see a caseworker, but in the long run it is worth it. You can sometimes be reimbursed from the time you apply to when you are approved if you have the receipts from your doctors and pharmacy. You would just need to take them to your caseworker and fill out a few forms. Let me know if this would be an option and I can help you go from there. Good luck in your recovery!

-CSD
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Unread 06-12-2009, 01:28 AM   #18
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Steve:

1. Do you have regular Medicare or a Medicare HMO? There are certain instances that are covered for Suboxone treatment, when it is provided in an inpatient or outpatient treatment center that is Medicare-certified according to the HHS. If you have an HMO, and it has substance abuse benefits, then you can see your physician. Medicare HMO's that have prescription drug benefits may cover Suboxone, according to the plan. Straight Medicare currently does not cover Suboxone when it is prescribed by a physician in an outpatient office.

2. Do you have a secondary insurance or Medicaid? Some secondary insurances will cover Suboxone if your Medicare will not, depending on the plan. Also, Medicaid may cover treatment and medication depending on the state where you have benefits. If you do have Medicaid, is it straight Medicaid or a Medicaid HMO?

Sorry about the long questions, I just need to know as much as I can about your coverage to provide you the best advice.

-CSD
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Unread 06-12-2009, 01:57 PM   #19
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Hi, i go in and out all the time ill check in later. Dawnny
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Unread 06-12-2009, 02:11 PM   #20
csdmommy
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Default My contact Information

Hey, guys.......I got online for a few minutes. If any of you wanted to E-mail me with any questions you don't want to post or you are sending me information that will help with your insurance concerns, please feel free to send them to the address I am giving here.

See you guys later!

-Christy
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Unread 06-14-2009, 06:08 PM   #21
chnmnny
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Hi csdmommy

The medicare number I was trying was 800-633-4227.

I have straight medicare, just had to drop my supplementary ins (Oxford) last year due to finances.

For some reason, they will not consider me for medicaid, even though with all my medical I can account for every penny of my SSD check. They also won't consider me for SSI for the same reason ( claim I recieve too muc from SSD).

The sub. was covered under my Med D policy, but as I went over the 2700.00 already, I have to pay full price. It was the MD visit I was wondering about. Also for the meds, I think I've exhausted every avenue. Hopefully You might have much more info than I had.

I really appreciate all the help and effort you are putting into this.

Hope everything is going well for you and your introduction to sub.

Many thanks again,
Steve
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Unread 06-14-2009, 08:58 PM   #22
csdmommy
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No problem Steve. After the kids and I get home after swimming lessons tomorrow, I will make some calls that I think can help you. Thank you for the support!
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Unread 06-15-2009, 05:30 PM   #23
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No prob, Steve. I'll send you E-mails, but I will also post here until they fix yours on Thursday.
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Unread 06-17-2009, 11:27 PM   #24
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csdmommy, they changed my hmo its effective july1 to horizon nj health , my sub docter is on it, and my daughters docter which is good. now i just have to see if i can find som therapy, ill let you know if i have a problem, but what i had americhoice there was nobody on it, it was terrible. thanks again dawnny
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Unread 06-18-2009, 12:22 AM   #25
csdmommy
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Dawnny:

I'm glad to hear that your insurance is now Horizon. Is it Horizon BCBS or just Horizon? Either way, I'm glad you are getting out of Americhoice! I always knew I had a fight on my hands when dealing w/ them! Let me know if there is anything else I can help with!

-Christy
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Unread 06-18-2009, 01:32 AM   #26
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csdmommy ~ what a helpful thread!

THANKS for replying to one of my posts & directing me here. My insurance book & paperwork i receive from them might as well be written in hieroglyphics for all i can manage to understand regarding their policies & fine print.

I myself have a PPO plan call 'four front 500' which is supposed to mean that my first four DR visits per year are totally covered. Since those visits were addiction related, they claim that they're exempt from absorbing all the cost.

Bone #2 to pick with these hustlers is that i'm supposed to have a 'stoploss limit' of $2,500 yet my share of medical bills so far this year is already well over $3,000 ... How does that math work??

And as of last month my suboxone co-pay has gone up from $40 to $60. WHY??
Better than with no insurance, i know, but they're nickel-&-diming techniques are breaking my bank. My last employer had me on an HMO, & i think that was much better for me

THANKS AGAIN ~ i would appreciate any clarity

~lu~
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Unread 06-18-2009, 10:58 AM   #27
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its horizon nj health. thanks for trying to help, i didnt know the renewal was up already and that i could change, i hope i have better luck with horizon, trying to find care when your on medicade is hard. mostly when you need a specialty docter. thanks again dawnny
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Unread 06-19-2009, 03:39 AM   #28
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dawnny:

I know what you mean about Medicaid. Many people I have helped have been in this same situation. You have Medicaid because you have a need for coverage, for you and your family (your daughter, in your case), but then when you actually need a doctor it is near impossible to find any who want to take it anymore.....let alone going through the heartache when you need a specialist and having to drive 100-200 miles to see one. I'm just glad you were able to switch.

If I can help w/ anything else, just let me know.

-Christy
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Unread 06-19-2009, 03:41 AM   #29
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Steve, did you receive my E-mail yesterday?
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Unread 06-19-2009, 03:53 AM   #30
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katbone:

Is your insurance through Paradigm Financial Services (Net Regence FourFront)? I am reviewing some of the documentation I have on them. Believe it or not I have a new member booklet, albeit it isn't the newest, but I can glean some information from it and get what I don't. Let me know and we can go from there in finding out your Suboxone/treatment benefits, as well as all of your other health benefits.

-Christy
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Unread 06-20-2009, 12:15 AM   #31
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yes Christy, it's Regence Blue Shield
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Unread 06-23-2009, 10:13 AM   #32
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Sorry I haven't been here in a few days. katbone, perfect, let me do some work for you.
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Unread 06-24-2009, 01:21 AM   #33
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CSDMOMMY,thankyou for the reply. dont have a plan,open enrollment,for my job isnt open again until,november.Public assistance wont cover opiate assistance.But not giving up so easy.iam am still searching for some coverage. thank you,marn
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Unread 06-24-2009, 08:34 AM   #34
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Good morning, marn71. Just wondering, are you currently on suboxone? I remember reading that you were going to see a dr who offered a sliding scale.

Anyway, I am inserting the post that Tim had put in about a new program offered by the makers of suboxone. Perhaps it can assist you. Best wishes,

Nan

...
NEW: (5/09) Get help finding a doctor from a live person with the Here To Help™ Program, call 866-956-9204 (Mon-Fri. 8:00am – 11:00pm Sat 8:00am-8:00pm ET) Speak to a live person who can help you find a doctor and coach you through the first 12 weeks of treatment. This is a free service offered by the manufacturer of Suboxone®.


http://www.addictionsurvivors.org/vb...ad.php?t=21259

More information can be found at www.naabt.org

Last edited by nan; 06-24-2009 at 08:38 AM..
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Unread 06-24-2009, 11:41 PM   #35
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Hi cdsmommy,

Just about think I got all the kins worked out with my computer. Idid'nt recieve any e-mails, but I'm going to go back and check my spam or junk mail in case its there. Although I put your e-mail address on my contact list.

Thanks again for all your efforts
Steve

P.S. Hope all is goiong well in your recovery!
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Unread 06-24-2009, 11:56 PM   #36
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Csdmommy

Forgot to tell you, hopall goes well with your MD appt Friday

Steve
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Unread 06-25-2009, 09:02 AM   #37
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morning.Thankyou for some of your advice,called the "here to help"# and realized we are on pacific time.So will try again today.Still looking for some coverage at least for pescription.150.00a week is a big bite,so want to keep reading and researching coverage.thank you to all of you out there!!
marn71
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Unread 06-26-2009, 01:00 PM   #38
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Thanks csdmommy,

I have Blue Shield shield spectrum PPO and I know our insurance is coming up for renewal. They approved my Sub (which I started yesterday) so now they know I have a substance abuse problem...and I am getting ready to go to a therapist for SA. I was wondering if insurance co's will not renew people with SA or if it is hard to get new insurance coverage once you have been diagnosed with SA. We pay for our insurance privately as my husband in an independent contractor and we cannot afford to lose it. Any help would be greatly appreciated.
Thanks, Frances
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Unread 06-29-2009, 07:33 AM   #39
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Hey, everybody!! Thanks, Steve, yes my appt went great, even though they had to move my day around due to Doc's vaca. No prob, though! My drug screens are clean and she even wrote my script w/ 2 refills due to my progress. I have been over on the west coast for the last week (at the beach house w/ the family on an island, we needed it!) so i have been offline, so bear w/ me everybody. I am getting back to work on the insurance stuff for you guys today. Hope everyone is well!
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Unread 07-01-2009, 03:54 PM   #40
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To csdmommy

Christy I was going to ask you about an insurance matter as i mentioned
in chat what is i am with a Sub doctor in one clinic out of town as i mentioned about the therapy matter is i need to see another sub doctor here in town to be approved for a therapist who i would really would like to see as he has experience with sub, This therapist tells me to come to this new doctor for a visit so as to have them give me the OK to see him well of course this takes an insurance approval and I'm concerned that my insurer will wonder why i am seeing two sub doctors and i don't want to put up any red flags and get into trouble my question to you is ? Do you think this could have an effect on my coverage and or raise suspension and
i could get in trouble i mean I'm not seeing two doctors but he is asking me to see two doctors so this is my concern this is very hard for me to explain and the reason for all this is convenience as not to drive 70 miles a trip for counseling if you understand all of this and you can give me an answer i sure appreciate this if not i do understand.

Thank You Tony.
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Unread 07-01-2009, 10:53 PM   #41
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Hey, Tony! I followed ya' the whole way.

Goodnight, honey (YES, I'm a deep-fried Southern Belle, everybody and we do still talk that way! Some of you are used to it by now!).

-Christy
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Unread 07-01-2009, 11:55 PM   #42
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Quote:
Originally Posted by csdmommy View Post
Hey, Tony! I followed ya' the whole way. I think I

Goodnight, honey (YES, I'm a deep-fried Southern Belle, everybody and we do still talk that way! Some of you are used to it by now!).

-Christy
Lol Your the best so helpfull to evryone thank you for being here i will be in touch with you in the morning i am up at 3:30 pt
i can email you then as it will still be early your time again thank you

Have a good evening everyone Tony
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Unread 07-02-2009, 06:38 AM   #43
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Hey, Tony, I just read your post and looked at the time....SCARY!!!!!! It's 6:34 here (Eastern Standard)....so 3:34 Pacific........hey! you know I get up around 5:30 most mornings....you're just trying to mess w/ me.

Just joking! No problem....give me just a little bit to get the day going and I'll take care of your insurance stuff. Alrighty?

Talk to you in a bit......

-Christy
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Unread 07-02-2009, 08:30 AM   #44
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Hey there Christy

I believe i have the right place here i got this through your email
am i right ?

I was up late helping a jess get through induction do you recall her she had told us all she had dosed on oxy at 2pm. and started sub at 6:45 pm.
any way this should help us get my email to you hope it works.

Thank You Tony
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Unread 07-02-2009, 08:43 AM   #45
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Hello Christy

I hope i did not make you go out of your way this morning for the 1st
time in months did i stay up late and i got on the site here with a poor little thing that couldent sleep and was scared to death her name was jess i had seen were you had posted her earlyer in the evening as well
we had thought she might not of went into withdrawl long enough as it turned out im sure she had by one of her reply,s the problom was that she started her first day on sub so late so i spent the late hours helping as much as i could. any whoot i slept in till 5:00 am Lol !

Ill be in touch..........Tony
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Unread 07-02-2009, 09:20 AM   #46
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tony, you are so good. you are a worry wort like me. what i like about you so much is you care about everybody. just wanted to let you know that. oh i heard from the govenor, i have to send some papers in. i dont know if its gona do anything, ill put it in dawnnys credit. look there
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Unread 07-02-2009, 10:27 AM   #47
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Quote:
Originally Posted by dawnny View Post
tony, you are so good. you are a worry wort like me. what i like about you so much is you care about everybody. just wanted to let you know that. oh i heard from the govenor, i have to send some papers in. i dont know if its gona do anything, ill put it in dawnnys credit. look there
Dawnny this could be a good thing if you want it to be im so happy you got the response.

Yes im a worry wort for sure i am reminded evry day by my ( D ) Lol

Again keep in touch or i will worry about you

K Bye Bye ......................................... Tony
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Unread 07-02-2009, 10:52 PM   #48
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Hi csdmommy I hope you can help me or atleast help me understand. I have caresource it is a medicade hmo plan for franklin county ohio. Well I was told that they would not cover my dr appiontments but that my medicince would be covered. Well When I went to CVS tonight that was the pharmacy the dr office told me to go to. They told me that it was going to be 107.00 for 1 week supply. My jaw dropped and my eyes filled up with tears and to tell you the truth I just lost it right there at the counter. I had just spent all the money I had to see the dr. The office visit cost me 400 dollars but it was well worth it. But anyways I was wondering if you knew anything about caresource? If you did is there anything I can do to get them to cover the medicine? Even if they were just to cover half I would be happy. Well Thanks for taking the time to read my post and I look forward to hearing from you soon! Take care!
Nichole
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Unread 07-07-2009, 03:59 AM   #49
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Blondi:

I have not forgotten about you, I promise!! I'm working on it.
-Christy
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Unread 07-26-2009, 04:20 PM   #50
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Hi csdmommy, how wonderful of you to volunteer your time! My situation is that I just got this awesome job which is beginning as a contract position through a staffing agency with the promise of becoming permanent in a couple months. the agency provides limited coverage insurance which is not currently active. I am going to ask my employer (not the agency) to at the least add me to their insurance plan until they make me a full employee. Luckily- I have a little bit of a leg to stand on with this, but that is another story lol. I am sure they have a great plan and I need to have something to cover the outrageous cost of my prescription. My question is- how long would it take them to activate me on their plan. Shouldn't they just be able to call the ins company and add me on right away? Aren't most mandatory waiting periods enforced by the employer and not the insurance company? Any insight would be great- thank-you!!
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