Author: nabbic
Posted: Thu Dec 22, 2011 4:03 am
Hello!
I know i havent posted here in quite some time. I started subs back in june of this year because of this forum and i am happy to say i am still going strong on them and haven’t had any relapses or even any issues since i started the suboxone!! I swear for the last 3 years i had been just taking pills to make me feel ‘normal’ and the sub does that for me perfectly and my life has improved so much since the first part of the year.
Anyway to my question.
I purchased a health insurance policy from my employer this year and i just had some questions because i have not used insurance with my subs yet.
So its Anthem BCBS of Colorado and we are on a formulary tired drug plan (they break different meds into tiers from 1 being generics to 3 being high priced brand names) I spoke to my benefits lady and she said Suboxone is covered under the tier 2 which would mean a $40 co pay. So i told her to go ahead and process my enrollment. She also said that buprenorphine was covered under tier 1 which confused me a little because i didn’t think there was a generic version?? The straight buprenorphine would be $10 she said. Anyone know about getting just buprenorphine as a generic?
Sorry i know this is a long and im jumping around a bit.
Ok after i spoke to my benefits lady i did some surfing on the web and found Anthem’s list of tiered drugs Tiered Drug List
now on this list it says Suboxone film and tabs require Pre autorization and it had Quantity Limits! The benefits lady didn’t tell me any of this and it is to late to change my enrollment information so i am kind of scared at this point. I tried to call Anthem but they didn’t have me on file yet so they said they couldn’t talk to me yet and give me detailed information on my plan?? Also after reading some posts online i am concerned about this being considered a Pre existing condition.
If anyone has any stories related to this or information that would be awesome i go to the doctor next week to get a new prescription and Anthem said they should have my information ready at that point and said i should call them then with my doctor but i would kind of like to know what to look forward to if possible.
One more thing lol (Sorry)
My doctor only takes cash but he said something when i first went to him about if i had insurance he could give me something to give them and they may cover the visits (didnt have insurance then so didn’t really pay much attention to it). Anyway i know my plan has a Substance Abuse/Behavioral health clause and was curious if anyone had any experience in submitting their own claims for a Sub doctor?
I really dont know anything about insurance i’m 25 and this is first time ive really carried it and i really only got it to help pay for the Subs. If i do file my own claims what would they reimburse me? Do i have to meet my $5000 deductible before they cover anything or what? Sorry i know i sound like an idiot lol but i would hate to be paying $150 a month for this insurance and it not cover any of this stuff and the preauthorization and quantity limits on the subs really is scaring me.
Sorry this was so long and if anyone has any help for me i would much appreciate it thanks!
-Nabbic
