Research Just Won Insurance Aoppeal

[Fembot]

I will post all study data and particulars in coming day or so for those facing denials for off script use of S U B O X O N E for pain management and lessening of complex PTSD symptoms. In OUR (thus not a one size fits all solution) case, this has been the only RX that has worked for effectively lessening physical pain arising from injuries and assisting with progress in spouse's psych therapy (5+ years now of S U B and....WEANING, which is something he could not do with traditional opiates, as you know, its quite the opposite with those). Of course, every insurance has different appellate rules and you'd do best to READ YOUR insurance HANDBOOK to meet and capitalize on those. Also, not every med works for everybody, but to the extent I can share the 8+ hours spent researching to put our appeal together, I would feel it worth it if someone else can also use any of the studies found to bolster/jump start their own independent research and appeal attempts (yes plural, as you may need to several levels of appeals), and you still may NOT win approval of that medication. Thus, NO of applicabilty to your situation is guaranteed, and no legal advice is implied or provided. Its up to you to formulate your own defense and strategy, weighed against both medical necessity and the rules in your plan handbook.

 

[Rumors]

Are you a troll here to sell suboxone to ptsd patients? Shame on you...

 

[Fembot]

Are you a troll here to sell suboxone to ptsd patients? Shame on you...

No. Arent you the pleasant one? Our lives were hell, and it worked for him. As I said, its not a one size fits all, and once posted you can use the info or ignore it (or do something else with it if you choose). Good luck with that tude...sheesh, thought we were here to support one another through this living hell. Perhaps I expect too much.

 

[Fembot]

I would encourage everyone to share their respective appeal research data for ALL procedures and ALL medications in this thread...not just the med we had issues getting reinstated. It may just prove helpful for someone faced with that devastating denial letter. Signed, a tired arse caregiver.

 

[Rumors]

Yeah, sorry I don't buy it. Your post is written too much like a lawyer, or a pharmaceutical junky. "No legal advice is implied or provided..." Not the average post...

 

[Fadeaway]

For all the horror stories I have heard about the drug, no thank you. I know people who used it to get off of addictive drugs only to end up far more addicted to Suboxone. This post does scream of a pharma shill.

 

[Fembot]

I am a paralegal...glad my education paid off. Sure hope that.doesnt mean I am not allowed to share MY family's experiences...? Did not know lawyers got paid to do that (doctors I could see)? Perhaps you should look up some of my posts before jumping to conclusions first.(been a member since Sept 2011)? If still not convinced, then there isn't a darn thing more I can I can do to help you with your unfounded suspicions. I am sure mangement can look me up, since.they have my real name and confirm on linkedin to see that I have been a paralegal for over 20 years. How about we flip the script? What if you then work for the insurance companies and are trying to keep folks from self educating by sharing independent research data on ALL medications in which they found promise or relief?

 

[Fembot]

If anyone wants the data I was able to unearth (Pubmed and elsewhere as the prescribing doc was next to useless in our appeal with a one paragraph contribution which he charged.us for...though his staff was great), just post here and I will share it. And again, please share your research data for procedures and other meds you sucessfully researched for your appeal(s). This thread could be a great resource for folks like situated.

 

[Fembot]

I wish someone would pay me for my years of independent reasearch work. I feel like i have two full time jobs (one 9-5'er and one fighting our insurance on the regular.) Every med is not for everybody, all here should understand that. If a med, any med, was working for YOU, and you were declined, I would like to think you'd be glad to share the info you compiled to fight your insurer. If this med doesnt apply to your treatment program, then why not share data which applies to yours rather than making false accusations? It could be about athlete's foot cream and if declined for it after using for 5 years, I'd sure as heck appreciate the shared info. Nothing more to be said to those who are going to be needlessly negative about a positive thread idea.

 

[Fembot]

For all the horror stories I have heard about the drug, no thank you. I know people who used it to get...

Its not about suggesting you or anyone else for that matter START using it if you are not already on it. That is between you and your doc and has NOTHING to do with the purpose of this thread. Its about those who have been on it for years, successfully, already and now their insurers have up and denied further refills.

 

[Fembot]

Sorry slow.posting/duplication

 

[Deleted member 1860]

My guess is that it's for pain .

Pain is not a ptsd symptom per se.

I know no doctor who would readily give suboxone to someone to treat a mental disorder .

As in pain spikes ptsd symptoms. This post is about suboxone for pain .The Op is being misleading.

It's the same as if someone said their diabetes spikes their ptsd so they take insulin to treat ptsd .

I'd expect more from a paralegal .Then again, maybe not bc that world is full of sharks who mince words to snag people up for their own personal gain. ie the legal world .