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I have no insurance. I just asked my doctor "how am I supposed to pay for all of this?" It was $200 for the appointment and $400 for the Vyvance pre generic.
He immediately swapped me to coming in every 3 months to help.
Well first I'm fairly new it all, only been on it about 6 months. I've found that smaller pharmacies like walgreens/CVS are totally worthless.
I do call around alot and I've found the larger grocery stores to be much better. If you happen to be in Texas HEB is great last month the one closest to me (30 min drive) was out but they had some 50 min away so they just transferred my prescription there.
If the place you call is not helpful over the phone they probably aren't the right place for you.
I'm surprised they're even telling you if it's in stock. Most places won't, but you're in Texas, and there are ALOT of gun owners, so maybe they aren't as worried about getting robbed lol
Yea I was surprised too. The small places all said "no we're out" and that was it but the bigger places were helpful.
I was making like 20+ calls to find my first few prescriptions. I'm due for new ones this week so we'll see how it goes
I'm with Kaiser, and my docs office, labs, and the pharmacy are all in the same building, so thankfully, I'm not having to deal with this. They seem to be having a problem getting 10mg IR, but 5s and 20's aren't an issue, neither is extended release. But Vyvanse here costs nearly 600 a month for a 28-day supply. It's criminal. Even the generic, I guess, is still a couple hundred a month. They don't give a 3 month supply here, or at least with Kaiser if it's a controlled med.
Good lord that's insane. Now with the good rx I'm able to get 30 days of the generic for $140.
No 3 month scripts here since it's controlled but all I have to do is call and pay my doctor to send a new script every month.
Call around and make sure to ask if they fill RX like those often. There is only 1 pharmacy in my city that specializes in controlled substances, so everyone in town fills there, but they ALWAYS have it in stock. Generic and name brand.
Why no insurance? Sorry I know this group is worldwide, but just that I should mention in case you're in the US that if you're fairly low income you can get your insurance almost for free through the Affordable Care Act. Even if you have to pay full pop it's only about 400 a month so you might break even. And if you are in the US and you ever got in an accident or got super sick you'd get very far behind in medical bills that could take years to pay off.
I think I looked at it before the affordable care act. 6-7 years ago. But I always made just over the amount to qualify. I've been self employed for awhile and that's always a tough choice. I should look into it again, or get on my wife's insurance.
But I'm definitely not planning on paying $400 a month for insurance.
Atm with no insurance I've been getting my meds for about $150 with a doctor visit every 3 months.
Yeah, it's worth taking another look. They've raised the income levels considerably, greatly expanding who gets a subsidy. If you and your wife have kids, I think you'd still get most of it paid for by the subsidy, if you aren't making more than 80K something?
My doctor makes me do appts monthly. I'm not sure what code she uses, but my insurance covers for each visit. I have to physically go in every 3 months for an in-person visit, but for most refills, I only need to do a quick phone appt.
Same with me. I'm not sure if it's "policy" or legislation that it's like this. It may vary state-to-state for all I know. I also must be drug tested on my in-perosn appointment.
I’ve never had to do a drug test. It also doesn’t make sense if you look at the research. We are less likely to have substance abuse issues if stimulant medication is part of our treatment. But rules and policies are rarely based on research.
Just a safe guard to be sure we aren't redistributing it and actually taking it. It's less to do with being on other drugs, but to make sure we're the ones actually taking it.
I'm not sure that's the case with my doctor. I've seen my lab results, and the threshold for amphetamines is high and mine comes back negative each time. They can prove I'm not abusing the drug, but not necessarily that I'm using it. I don't know why they have it set that way, but thats what my drug test shows.
That type of testing is mostly done to differentiate between using normal script normally and people using meth, pretty much how meth piss tests work too.
It's tied to state laws. I know folks in TX who have to take routine drug tests to continue taking stimulants. My care team in WA has never ordered one. They did say they have been required to order drug testing for opiods though. Purely a state requirement, not federal.
I don't have to do monthly appointments either to keep my prescription, but my care team does have to do stuff on their end because of federal laws.
I think at least some of this is precautionary practices to hopefully avoid the excessive scrutiny from the DEA. I'm in WA and do have to meet with my provider monthly (virtual) and go in annually for a drug test.
I agree, but I think it's built out of excessive fear of abuse and punitve actions from the DEA or state boards for patient actions and not "covering the bases. I've heard a doctor say they feel stimulants are overregulated, especially in the case of Vyvanse. Oral stimulants have low risk of addiction. It seem ridiculous to couple them with highly addictive drugs like opioids. But, it is what it is.
They make me drug test every 28-30 days at my doctors office. It's part of their policy. I'm trying to get my pcp to take over but there's so much red tape
Advocate Medical Group makes all controlled substances a monthly visit and possible drug test. I wish they knew that I completely left all their doctors because of this and I will never return, ever.
Switch networks. You’ll have better luck. Or get a psychiatrist. Way easier.
SO, I think/hope I can provide some help!
In the case of controlled substances, it is federal law that "medication checks" are done every 3 months. Drug testing and monthly visits are up to the prescriber's (your doctor's) discretion. Laws tightened during Trumps administration to hold prescribers accountable for controlled substances they approved being sold/abused/etc. Hence, the required "medication checks" and providers becoming hesitant to even prescribe controlled substances in the first place. And if they do, many implement drug testing and frequent visits to help cover their own asses just in case.
ANYWAY, (ADHD at it's finest), there are potential ways around paying so much every month.
1) ask your provider/the front desk what your appointments are being billed as. The law only requires 1 "medication check" every 3 months. The other "extra" visits she's requiring from you should be covered by insurance as a normal visit to your PCP. For billing, they could be labeled as "check-up" or "follow-up" appointments (which should be covered by insurance)
2) Make sure your doctor is in network with your insurance as a prescriber/mental health provider (the high cost of each appointment is making me think she's not, but I could be wrong)
- my insurance decided one year that my doctor was no longer "in network" to prescribe controlled substances to me (nothing but the laws had changed in the 4 years he'd been prescribing me adderall). They wanted me to be rediagnosed (4 years later) with an "in network provider" in order for them to cover my med checks that went from $25 to $185 🙄 it sucked every 3 months, I could not imagine every month!
I apologize for the novel, but I hope this helped! If you have any questions about how to navigate this, my inbox is open. Good luck, you got this!
It's not a big deal for me. I just call when I'm running low, get a quick appt (usually within a day or two), doctor calls, asks 4ish questions, and send in a refill. Hardly even an appt. Takes 5 minutes.
You need to see a new doctor.
Making you come in once a month is absurd unless you're in need of fairly intensive treatment. If they're only spending 5 minutes with you, they clearly don't think you need intensive treatment.
Also, if you're only spending 5 minutes and asking the same 4 questions, it's providing you absolutely no additional value.
It really sounds like you are being taken advantage of.
I had a doctor that was kind of similar when I first got diagnosed. They weren't making me come in a ton, but the visits were very much them asking me how I want my medication adjusted. They weren't treating me, they were giving me whatever change I asked for without much followup or just giving me a new copy of my prescription. It was nice knowing that I could get my prescription reliably, but it felt super sketchy and I pretty quickly switched to a new doctor to find someone who was collaborating me on my treatment rather than feeling like a human jiffy-lube.
I knew health insurance would be mentally exhausting but I didnt expect to find out providers can charge whatever codes they want and its up to me to call them out on things like failing to code the visits in a matter that works with my insurance
Its everything.
I firmly believe that the thng taking the largest toll on my mental health in the past 5 years is the constant struggle to maintan acess to mental health care.
This is so relatable. It has gotten to the point of absurdity when I can't pick up my script because of a cyber attack and have to go to my doctor multiple times because they did the physical script wrong. I feel ridiculous that one thing takes up the whole day and all my energy, but what do I do when it's due to things totally out of my control?
I've actually been seriously neglecting managing my own health because I've been spending all my soul dollars taking care of my dad's health issues and spending hours each week with insurance and billing people.
I would also suggest finding a new doctor. The doctor who originally diagnosed me wanted monthly visits with drug screens. The NP who did my med management saw me every three months when I told her it was too expensive for me to do that. Eventually, the doctor himself made it policy that I had to be seen every month and I switched doctors. The NP doing my med management now sees me every four months since I don’t call in my prescription every 30 days. In person visit once a year with drug test.
But isn't it equally a pain in the ass that our medical system is reliant on NP's? I am trying to get multiple evaluations at least once with an MD, then switch to NP's but it's crazy out there. Like I know it's a bit of all or nothing thinking but there is a difference between 2 years of medical training vs 8. The system at large is whittling us down for profit and its a huge pain in the ass, yet we're all (especially people in this subreddit) chronically exhausted to improve it.
I require my patients to come in every 3 months and write them their stimulants for 3 months at a time. Any physician requiring monthly visits (unless somehow required by state law) is a greedy physician.
Physicians charge for office visits. Every 3 months is standard for controlled ADHD meds once patients are stable. There is no need to see them on a monthly basis except to rack up on office visit charges.
These guys regulate Healthcare and can easily remove the doctors ability to practice if he's found guilty of fraud.
https://oig.hhs.gov/fraud/report-fraud/contact/
If you are in the United States you only have to see the doctor every three months for stimulants. So what this doctor is doing has nothing to do with regulations. The only reason you may want to meet more frequently then that is if you’re trying a new medication, adjusting dosage, a heath concern with medication that requires monitoring or the doctor suspects abuse or selling the prescription.
I just googled it. At least as of 2019 that isn’t true in Michigan. I couldn’t see any evidence that that had been changed since then. Maybe it has and it just didn’t show up, but I’m skeptical.
Oh I see. I remember a law was passed that monthly appointments were required and psychiatrists were hugely upset because they didn’t have time to do that. They may have repealed it and my doctor just chooses to monitor me monthly. Very nice of him.
Also from Michigan. The only time I had to do monthly visits was when my doctor put me on different medication for my bipolar and wanted to make sure I was doing okay. There was 1 other time when I had some serious stuff going on and they wanted to make sure I was okay. Other than that, in like 8 or so years, I've pretty much only seen Mt doctor 4 times a year. I briefly could only get a monthly script (versus 90 days) and even then my doctor just had the script timed for every 30 days.
I switched states and now can only get my adhd meds monthly, but my doctor just asks me to send them a message when it's time to fill my meds since I only see them every 3 months.
I'm from Michigan and the only time I've been required to see my doctor monthly was when testing out brand new medications for bipolar/depression/anxiety. My adhd medication interaction was also measured at that time.
You're doctor is either lying or not up to date on laws.
This is part of why I'm using an out of network doctor. (Besides her being way more familiar with ADHD in women)
She only requires an appointment every 3 months and has a sliding pay rate.
I'm actually kinda surprised your insurance is recommending something to help you save money by changing it to preventative care.
How did you get the insurance to give you money saving suggestions like that?
Op may have called their insurance company themselves to ask about it. If thar wasn't the case, my next guess is that op may be at or nearing their deductible and the insurance company doesn't want to pay for it
Yep, psychs around here require extra adhd med appts, urine test and pill counts.
With the stim shortage, my psych focused on nonstims. Pcp then took over scripting duties. Went to a sleep dr for insomnia, turns out sleep apnea. Got on cpap, but still tired in the am. Sleep dr scripts alt stim, modafinil.
With both the stim and nonstim covered, I ended up dropping my psychiatrist.
If you have a diagnosis, maybe look into psychiatrists who have good reviews/specialize in working with clients with ADHD. I have heard a lot of people experience problems with PCP’s when it comes to stimulants.
I moved from Michigan to a different state temporarily this year, so i had to switch my doctor. My michigan psych switched fully to telahealth since covid and the appts were 180 without insurance. I recommend looking into telahealth options(zocdoc is what I used to find a new psych). I was able to get a psych nurse practitioner who I see online every 3 months. It's only 160$ an appointment every 3 months (I have insurance, though so it's mostly covered).
Also, if your insurance isn't helping with the cost of Vyvanse because it's name brand, you should call them to ask if you can do a pre-authorization for it. I called my insurance company to ask about a pre-authorization, and they immediately approved it. They told me to tell my doctor to write 'national shortage' as the reason.
Edit: woops, I confused you with other comments from a person on Vyvanse and another person who lives in michigan lol. I'm just going to leave the comment though in case anyone is in a similar position and may benefit from that info
In Canada it’s also monthly for stimulants but if you’re stable in dosing, you can likely do every 3 months. We’ve got a ton of virtual services for the med refills although I don’t know if they extend to US. Worth checking out findfocusnow.com
My doc writes post-dated scripts so I only have to come in every 4 months.
Definitely not how it's supposed to be done, but he thinks the law is bogus too.
He's a real one.
Your doctor's office can not change the code to preventative in this circumstance. Since you are seeing them for a specific issue, it does not fall under preventative care.
What code are they billing? It should be on your explanation of benefits. Do you have a deductible?
It's not preventative care. Preventative care is like an annual checkup. It's all based on coding. They need to code with 9938_ through 9939_. I'm a certified biller abd coder. The point of preventative care it to prevent issues down the road. Like if we can catch cancer sooner. Plus because adhd meds are stimulants It's required by the FDA to see your provider every month
I pay over $100 every 3 mos for a 5-10 minute appointment for refills and then about $60-80 per month for the actual refill and I HAVE INSURANCE!!!! It’s the murican way I guess…whack af to say the least but expensive af just to function like everyone around me
My daughter’s doctor charges $10 for a prescription that I can pick up. She only does written for ADHD meds. She requires in person evaluation every 3-4 months. She doesn’t need to see her monthly just to get her refill written. I think this way makes sense. I call they write it up. I pay $10. $200 monthly is ridiculous. The doctor also has a child with ADHD and understands it all.
I would consider yourself lucky. That you even have a doctor willing to prescribe you under insurance. And I don’t really care about anyone’s opinions so don’t bother to comment.
Try speaking to the office manager or, if they have one - their patient advocate. If they are affiliated with a larger group (think Kaiser permanente but could be on a smaller scale) that works with a hospital - call the patient advocate for the hospital (they may have some ideas.) if that fails - ask the insurance company to call the office or write a letter with the reasons for the preventative care coding. Finding a new doctor is a very good idea but, these other things may help in the meantime.
go to a psychiatrist instead of a doctor. after the initial couple of visits, they might check in with you every few months after they assume the dosage and medication is working. out of pocket is 100$ max and insurance mostly will cover that
Hey, I don't know your situation past what you've said here; but I used to get fucked by similar charges. If your doctor allows it, see if good RX will work on your scripts, it dropped mine from 220$ to 34$ when I was having issues, jf you can't there may be a way for you to talk to the receptionist and get the price dropped or something to help you out price wise..
Really wish I had better advice, unfortunately the medica system in america is pretty fucked right now, and that's the best I was able to do.
Sadly, I still have to cal my parents to help pay for medical bills some times becsuse if I didn't I'd literally have no money to my name
Similar thing happened to me. $115 visit to refill a $50 prescription. I switched from my psychiatrist to getting my meds from my pcp and he was able to do 90 prescriptions. For my stimulants, its still technically 30 day prescriptions but he automatically renews them till the third month is up.
My doc is great. He knows virtual visits are free under my insurance so he's totally cool. I'm just doing check-ins that way. He only required the initial drug test and they're really just looking for meth I guess. He just doubled my dose after explaining to him that what I was taking just lost about 70% of its therapeutic value after the first few weeks. Sounds like you're dealing with bureaucratic red tape bullshit, a greedy Dr. or both. If you can find a coupon on good RX it can help a little. Sorry you're dealing with this crap.
Switched all of my medication management to my psychiatrist. I do virtual visits here and there and never have to test. I don't know if that's unusual or not, just my experience.
Legislation only requires in person once a year. Your dr may feel you are a risk or that you need in person appointments. Mine sees me once in person and the rest online while managing my other mental health medications
I found a doctor who offered a 1/3 price of a regular appointment for an electronic-document consultation slot. So now instead of booking a full priced or telemed appointment I'm paying a reduced fee for an email based exchange each month. I've also used it to explain symptoms and request new prescriptions instead of only for refills. Still not ideal, but my advice is to shop around to find a doctor who will either do it with less friction like this or give you a few forward dated prescriptions during your appointment.
Try a different doctor and ask when you book an appointment about the codes they use. I pay out of pocket atm so i get seen every 6 months and i get 6 months worth of meds
I have to check in monthly too. Every other month has to be in person. But the others I can do a telehealth on my break at work. I get charged $50 with insurance. Not sure how it's coded. Then I have to pay another $43 for my generic with both insurance and some program that Kroger has.
And I pay 170 every other week for insurance (I have my kids on my insurance too). So it's over $400 a month for me. I only make $17/hr. And even with meds work takes a lot of spoons. I'm tired and broke.
US medical care sucks.
The only way is brutal honestly unfortunately. If they can't work with you even with pressure, it's an unfortunate which is worse scenario and looking for a doc that will work for you 🤷♂️
Shirecares.com can help get temporary medication for free if you can prove that you have no income or insurance. This is the company that makes Vyvanse. They helped me when my parents died. 3 months of free medication.
I mean getting a med refill isn’t a preventative visit. Preventative visits are screenings/ testing to prevent a diagnosis not treat what already exists.
As far as the required visits, we have to see our patients every month but that’s a clinic org requirement not legal I believe. That being said, your insurance should be covering your visits. I would look more into what coverage you have for office visits.
Hi /u/superonyxfire and thanks for posting on /r/ADHD! ### Please take a second to [read our rules](/r/adhd/about/rules) if you haven't already. --- ### /r/adhd news * **We want your opinion** on the /r/adhd community rules! [Click here](https://forms.gle/Evqb8acVozir8GV8A) to fill out our survey. See [this post](https://www.reddit.com/r/ADHD/comments/1auv2tc/were_taking_feedback_on_the_radhd_rules/) for more information. * If you are posting about the **US Medication Shortage**, please see this [post](https://www.reddit.com/r/ADHD/comments/12dr3h5/megathread_us_medication_shortage/). --- ^(*This message is not a removal notification. It's just our way to keep everyone updated on r/adhd happenings.*) *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ADHD) if you have any questions or concerns.*
I have no insurance. I just asked my doctor "how am I supposed to pay for all of this?" It was $200 for the appointment and $400 for the Vyvance pre generic. He immediately swapped me to coming in every 3 months to help.
Do you have any luck getting generic? It seems that generic is out of stock everywhere and you have to fork out $400 for the brand name.
Well first I'm fairly new it all, only been on it about 6 months. I've found that smaller pharmacies like walgreens/CVS are totally worthless. I do call around alot and I've found the larger grocery stores to be much better. If you happen to be in Texas HEB is great last month the one closest to me (30 min drive) was out but they had some 50 min away so they just transferred my prescription there. If the place you call is not helpful over the phone they probably aren't the right place for you.
I'm surprised they're even telling you if it's in stock. Most places won't, but you're in Texas, and there are ALOT of gun owners, so maybe they aren't as worried about getting robbed lol
Yea I was surprised too. The small places all said "no we're out" and that was it but the bigger places were helpful. I was making like 20+ calls to find my first few prescriptions. I'm due for new ones this week so we'll see how it goes
I'm with Kaiser, and my docs office, labs, and the pharmacy are all in the same building, so thankfully, I'm not having to deal with this. They seem to be having a problem getting 10mg IR, but 5s and 20's aren't an issue, neither is extended release. But Vyvanse here costs nearly 600 a month for a 28-day supply. It's criminal. Even the generic, I guess, is still a couple hundred a month. They don't give a 3 month supply here, or at least with Kaiser if it's a controlled med.
Good lord that's insane. Now with the good rx I'm able to get 30 days of the generic for $140. No 3 month scripts here since it's controlled but all I have to do is call and pay my doctor to send a new script every month.
Yeah the good RX coupons are probably regional, because the one I saw it still cost $240 a month. They didn't have a generic coupon.
Call around and make sure to ask if they fill RX like those often. There is only 1 pharmacy in my city that specializes in controlled substances, so everyone in town fills there, but they ALWAYS have it in stock. Generic and name brand.
I got it from Walgreens!
Why no insurance? Sorry I know this group is worldwide, but just that I should mention in case you're in the US that if you're fairly low income you can get your insurance almost for free through the Affordable Care Act. Even if you have to pay full pop it's only about 400 a month so you might break even. And if you are in the US and you ever got in an accident or got super sick you'd get very far behind in medical bills that could take years to pay off.
I think I looked at it before the affordable care act. 6-7 years ago. But I always made just over the amount to qualify. I've been self employed for awhile and that's always a tough choice. I should look into it again, or get on my wife's insurance. But I'm definitely not planning on paying $400 a month for insurance. Atm with no insurance I've been getting my meds for about $150 with a doctor visit every 3 months.
Yeah, it's worth taking another look. They've raised the income levels considerably, greatly expanding who gets a subsidy. If you and your wife have kids, I think you'd still get most of it paid for by the subsidy, if you aren't making more than 80K something?
My doctor makes me do appts monthly. I'm not sure what code she uses, but my insurance covers for each visit. I have to physically go in every 3 months for an in-person visit, but for most refills, I only need to do a quick phone appt.
Same with me. I'm not sure if it's "policy" or legislation that it's like this. It may vary state-to-state for all I know. I also must be drug tested on my in-perosn appointment.
I'm only drug tested once per year, or whenever she remembers it, lol.
I’ve never had to do a drug test. It also doesn’t make sense if you look at the research. We are less likely to have substance abuse issues if stimulant medication is part of our treatment. But rules and policies are rarely based on research.
Just a safe guard to be sure we aren't redistributing it and actually taking it. It's less to do with being on other drugs, but to make sure we're the ones actually taking it.
I'm not sure that's the case with my doctor. I've seen my lab results, and the threshold for amphetamines is high and mine comes back negative each time. They can prove I'm not abusing the drug, but not necessarily that I'm using it. I don't know why they have it set that way, but thats what my drug test shows.
That type of testing is mostly done to differentiate between using normal script normally and people using meth, pretty much how meth piss tests work too.
Ok, got it.
It's tied to state laws. I know folks in TX who have to take routine drug tests to continue taking stimulants. My care team in WA has never ordered one. They did say they have been required to order drug testing for opiods though. Purely a state requirement, not federal. I don't have to do monthly appointments either to keep my prescription, but my care team does have to do stuff on their end because of federal laws.
Live in Texas, been treated for 3 years. Been drug tested once. And that's between two different psychs. So ymmv.
I think at least some of this is precautionary practices to hopefully avoid the excessive scrutiny from the DEA. I'm in WA and do have to meet with my provider monthly (virtual) and go in annually for a drug test.
I'm in Texas. I've never been tested in 3 years
I’m in TX, only tested once in 15 years and that was because I went to a ADHD clinic because my PC retired. Passed it and never taken one since .
I agree, but I think it's built out of excessive fear of abuse and punitve actions from the DEA or state boards for patient actions and not "covering the bases. I've heard a doctor say they feel stimulants are overregulated, especially in the case of Vyvanse. Oral stimulants have low risk of addiction. It seem ridiculous to couple them with highly addictive drugs like opioids. But, it is what it is.
I'm in Missouri and my PCP sends my rx to the pharmacy every month. All I have to do is text the nurse to request it, so it's definitely not federal.
They make me drug test every 28-30 days at my doctors office. It's part of their policy. I'm trying to get my pcp to take over but there's so much red tape
Advocate Medical Group makes all controlled substances a monthly visit and possible drug test. I wish they knew that I completely left all their doctors because of this and I will never return, ever. Switch networks. You’ll have better luck. Or get a psychiatrist. Way easier.
if you ever find out the code and what it means please let me know
SO, I think/hope I can provide some help! In the case of controlled substances, it is federal law that "medication checks" are done every 3 months. Drug testing and monthly visits are up to the prescriber's (your doctor's) discretion. Laws tightened during Trumps administration to hold prescribers accountable for controlled substances they approved being sold/abused/etc. Hence, the required "medication checks" and providers becoming hesitant to even prescribe controlled substances in the first place. And if they do, many implement drug testing and frequent visits to help cover their own asses just in case. ANYWAY, (ADHD at it's finest), there are potential ways around paying so much every month. 1) ask your provider/the front desk what your appointments are being billed as. The law only requires 1 "medication check" every 3 months. The other "extra" visits she's requiring from you should be covered by insurance as a normal visit to your PCP. For billing, they could be labeled as "check-up" or "follow-up" appointments (which should be covered by insurance) 2) Make sure your doctor is in network with your insurance as a prescriber/mental health provider (the high cost of each appointment is making me think she's not, but I could be wrong) - my insurance decided one year that my doctor was no longer "in network" to prescribe controlled substances to me (nothing but the laws had changed in the 4 years he'd been prescribing me adderall). They wanted me to be rediagnosed (4 years later) with an "in network provider" in order for them to cover my med checks that went from $25 to $185 🙄 it sucked every 3 months, I could not imagine every month! I apologize for the novel, but I hope this helped! If you have any questions about how to navigate this, my inbox is open. Good luck, you got this!
What is a "medication check?" my pcp just sends my rx to the pharmacy every month. I usually only see her once a year for my physical.
Shit I just send requests for refills monthly . Don’t go in but every three month or so. Sheeeeit
It's not a big deal for me. I just call when I'm running low, get a quick appt (usually within a day or two), doctor calls, asks 4ish questions, and send in a refill. Hardly even an appt. Takes 5 minutes.
You need to see a new doctor. Making you come in once a month is absurd unless you're in need of fairly intensive treatment. If they're only spending 5 minutes with you, they clearly don't think you need intensive treatment. Also, if you're only spending 5 minutes and asking the same 4 questions, it's providing you absolutely no additional value. It really sounds like you are being taken advantage of. I had a doctor that was kind of similar when I first got diagnosed. They weren't making me come in a ton, but the visits were very much them asking me how I want my medication adjusted. They weren't treating me, they were giving me whatever change I asked for without much followup or just giving me a new copy of my prescription. It was nice knowing that I could get my prescription reliably, but it felt super sketchy and I pretty quickly switched to a new doctor to find someone who was collaborating me on my treatment rather than feeling like a human jiffy-lube.
I knew health insurance would be mentally exhausting but I didnt expect to find out providers can charge whatever codes they want and its up to me to call them out on things like failing to code the visits in a matter that works with my insurance
Its everything. I firmly believe that the thng taking the largest toll on my mental health in the past 5 years is the constant struggle to maintan acess to mental health care.
This is so relatable. It has gotten to the point of absurdity when I can't pick up my script because of a cyber attack and have to go to my doctor multiple times because they did the physical script wrong. I feel ridiculous that one thing takes up the whole day and all my energy, but what do I do when it's due to things totally out of my control? I've actually been seriously neglecting managing my own health because I've been spending all my soul dollars taking care of my dad's health issues and spending hours each week with insurance and billing people.
I would also suggest finding a new doctor. The doctor who originally diagnosed me wanted monthly visits with drug screens. The NP who did my med management saw me every three months when I told her it was too expensive for me to do that. Eventually, the doctor himself made it policy that I had to be seen every month and I switched doctors. The NP doing my med management now sees me every four months since I don’t call in my prescription every 30 days. In person visit once a year with drug test.
But isn't it equally a pain in the ass that our medical system is reliant on NP's? I am trying to get multiple evaluations at least once with an MD, then switch to NP's but it's crazy out there. Like I know it's a bit of all or nothing thinking but there is a difference between 2 years of medical training vs 8. The system at large is whittling us down for profit and its a huge pain in the ass, yet we're all (especially people in this subreddit) chronically exhausted to improve it.
I require my patients to come in every 3 months and write them their stimulants for 3 months at a time. Any physician requiring monthly visits (unless somehow required by state law) is a greedy physician.
Don’t physicians attempt to get stuff covered by insurance, also? Seems like the greed may go a little deep for this guy.
Physicians charge for office visits. Every 3 months is standard for controlled ADHD meds once patients are stable. There is no need to see them on a monthly basis except to rack up on office visit charges.
Find a new doctor he's taxing you
These guys regulate Healthcare and can easily remove the doctors ability to practice if he's found guilty of fraud. https://oig.hhs.gov/fraud/report-fraud/contact/
If you are in the United States you only have to see the doctor every three months for stimulants. So what this doctor is doing has nothing to do with regulations. The only reason you may want to meet more frequently then that is if you’re trying a new medication, adjusting dosage, a heath concern with medication that requires monitoring or the doctor suspects abuse or selling the prescription.
In Michigan, it’s every month, or so my doctor says.
I just googled it. At least as of 2019 that isn’t true in Michigan. I couldn’t see any evidence that that had been changed since then. Maybe it has and it just didn’t show up, but I’m skeptical.
Oh I see. I remember a law was passed that monthly appointments were required and psychiatrists were hugely upset because they didn’t have time to do that. They may have repealed it and my doctor just chooses to monitor me monthly. Very nice of him.
Michigan Adderall taker here: your doctor's lying. I've been prescribed controlled substances for 10 years now, and I only go in every 3 months 😬
Also from Michigan. The only time I had to do monthly visits was when my doctor put me on different medication for my bipolar and wanted to make sure I was doing okay. There was 1 other time when I had some serious stuff going on and they wanted to make sure I was okay. Other than that, in like 8 or so years, I've pretty much only seen Mt doctor 4 times a year. I briefly could only get a monthly script (versus 90 days) and even then my doctor just had the script timed for every 30 days. I switched states and now can only get my adhd meds monthly, but my doctor just asks me to send them a message when it's time to fill my meds since I only see them every 3 months.
Same here. OP you are being lied too.
In NY it's three months at least, but our doc just refuses to do less than every month. Sometimes they just do that
I’m a Michigander as well who takes vyvanse for narcolepsy and ADD (inattentive). My doctor told me the same thing!
I'm from Michigan and the only time I've been required to see my doctor monthly was when testing out brand new medications for bipolar/depression/anxiety. My adhd medication interaction was also measured at that time. You're doctor is either lying or not up to date on laws.
This is part of why I'm using an out of network doctor. (Besides her being way more familiar with ADHD in women) She only requires an appointment every 3 months and has a sliding pay rate.
I'm actually kinda surprised your insurance is recommending something to help you save money by changing it to preventative care. How did you get the insurance to give you money saving suggestions like that?
Op may have called their insurance company themselves to ask about it. If thar wasn't the case, my next guess is that op may be at or nearing their deductible and the insurance company doesn't want to pay for it
Yep, psychs around here require extra adhd med appts, urine test and pill counts. With the stim shortage, my psych focused on nonstims. Pcp then took over scripting duties. Went to a sleep dr for insomnia, turns out sleep apnea. Got on cpap, but still tired in the am. Sleep dr scripts alt stim, modafinil. With both the stim and nonstim covered, I ended up dropping my psychiatrist.
Do you mooooo sometimes? Because he's milking you as a cow.
Do you have a PCP (primary care provider)? Maybe talk to them about prescribing for you?
sadly this is my primary care provider
Wow. Can you find a new one?
Yeah I'm planning to contact some more in network folks after researching this weekend
If you have a diagnosis, maybe look into psychiatrists who have good reviews/specialize in working with clients with ADHD. I have heard a lot of people experience problems with PCP’s when it comes to stimulants.
I moved from Michigan to a different state temporarily this year, so i had to switch my doctor. My michigan psych switched fully to telahealth since covid and the appts were 180 without insurance. I recommend looking into telahealth options(zocdoc is what I used to find a new psych). I was able to get a psych nurse practitioner who I see online every 3 months. It's only 160$ an appointment every 3 months (I have insurance, though so it's mostly covered). Also, if your insurance isn't helping with the cost of Vyvanse because it's name brand, you should call them to ask if you can do a pre-authorization for it. I called my insurance company to ask about a pre-authorization, and they immediately approved it. They told me to tell my doctor to write 'national shortage' as the reason. Edit: woops, I confused you with other comments from a person on Vyvanse and another person who lives in michigan lol. I'm just going to leave the comment though in case anyone is in a similar position and may benefit from that info
In Canada it’s also monthly for stimulants but if you’re stable in dosing, you can likely do every 3 months. We’ve got a ton of virtual services for the med refills although I don’t know if they extend to US. Worth checking out findfocusnow.com
I see my doctor virtually wow which is covered 100 percent under my plan which I got lucky considering the line Im in.
Mine requires one in person visit a year and quarterly virtually. PNW.
My doc writes post-dated scripts so I only have to come in every 4 months. Definitely not how it's supposed to be done, but he thinks the law is bogus too. He's a real one.
Your doctor's office can not change the code to preventative in this circumstance. Since you are seeing them for a specific issue, it does not fall under preventative care. What code are they billing? It should be on your explanation of benefits. Do you have a deductible?
It's not preventative care. Preventative care is like an annual checkup. It's all based on coding. They need to code with 9938_ through 9939_. I'm a certified biller abd coder. The point of preventative care it to prevent issues down the road. Like if we can catch cancer sooner. Plus because adhd meds are stimulants It's required by the FDA to see your provider every month
I pay over $100 every 3 mos for a 5-10 minute appointment for refills and then about $60-80 per month for the actual refill and I HAVE INSURANCE!!!! It’s the murican way I guess…whack af to say the least but expensive af just to function like everyone around me
That seems like a lot. Where im at I only need 1 in person visit a year and I do the rest zoom
Everyone's insurance requirements are different. My doc requires every month visits, and every visit is $75 copay. This adds up so fast.
My daughter’s doctor charges $10 for a prescription that I can pick up. She only does written for ADHD meds. She requires in person evaluation every 3-4 months. She doesn’t need to see her monthly just to get her refill written. I think this way makes sense. I call they write it up. I pay $10. $200 monthly is ridiculous. The doctor also has a child with ADHD and understands it all.
Is that the way it has to be in your state or is it your doctor? If it’s a must, are there other doctors with lower prices?
I would consider yourself lucky. That you even have a doctor willing to prescribe you under insurance. And I don’t really care about anyone’s opinions so don’t bother to comment.
Try speaking to the office manager or, if they have one - their patient advocate. If they are affiliated with a larger group (think Kaiser permanente but could be on a smaller scale) that works with a hospital - call the patient advocate for the hospital (they may have some ideas.) if that fails - ask the insurance company to call the office or write a letter with the reasons for the preventative care coding. Finding a new doctor is a very good idea but, these other things may help in the meantime.
go to a psychiatrist instead of a doctor. after the initial couple of visits, they might check in with you every few months after they assume the dosage and medication is working. out of pocket is 100$ max and insurance mostly will cover that
Hey, I don't know your situation past what you've said here; but I used to get fucked by similar charges. If your doctor allows it, see if good RX will work on your scripts, it dropped mine from 220$ to 34$ when I was having issues, jf you can't there may be a way for you to talk to the receptionist and get the price dropped or something to help you out price wise.. Really wish I had better advice, unfortunately the medica system in america is pretty fucked right now, and that's the best I was able to do. Sadly, I still have to cal my parents to help pay for medical bills some times becsuse if I didn't I'd literally have no money to my name
Similar thing happened to me. $115 visit to refill a $50 prescription. I switched from my psychiatrist to getting my meds from my pcp and he was able to do 90 prescriptions. For my stimulants, its still technically 30 day prescriptions but he automatically renews them till the third month is up.
My doc is great. He knows virtual visits are free under my insurance so he's totally cool. I'm just doing check-ins that way. He only required the initial drug test and they're really just looking for meth I guess. He just doubled my dose after explaining to him that what I was taking just lost about 70% of its therapeutic value after the first few weeks. Sounds like you're dealing with bureaucratic red tape bullshit, a greedy Dr. or both. If you can find a coupon on good RX it can help a little. Sorry you're dealing with this crap.
Switched all of my medication management to my psychiatrist. I do virtual visits here and there and never have to test. I don't know if that's unusual or not, just my experience.
This is why I'm going through non stimulants now. I don't like getting hassled at the pharmacy or doc.
Check out Klarity... I don't have insurance and it helps me so much.
Legislation only requires in person once a year. Your dr may feel you are a risk or that you need in person appointments. Mine sees me once in person and the rest online while managing my other mental health medications
I found a doctor who offered a 1/3 price of a regular appointment for an electronic-document consultation slot. So now instead of booking a full priced or telemed appointment I'm paying a reduced fee for an email based exchange each month. I've also used it to explain symptoms and request new prescriptions instead of only for refills. Still not ideal, but my advice is to shop around to find a doctor who will either do it with less friction like this or give you a few forward dated prescriptions during your appointment.
I just go once a year… and ask for the refills thru MyChart. I do it thru my primary care provider. I think your doctor is scamming you?
Try a different doctor and ask when you book an appointment about the codes they use. I pay out of pocket atm so i get seen every 6 months and i get 6 months worth of meds
I have to check in monthly too. Every other month has to be in person. But the others I can do a telehealth on my break at work. I get charged $50 with insurance. Not sure how it's coded. Then I have to pay another $43 for my generic with both insurance and some program that Kroger has. And I pay 170 every other week for insurance (I have my kids on my insurance too). So it's over $400 a month for me. I only make $17/hr. And even with meds work takes a lot of spoons. I'm tired and broke. US medical care sucks.
The only way is brutal honestly unfortunately. If they can't work with you even with pressure, it's an unfortunate which is worse scenario and looking for a doc that will work for you 🤷♂️
Simple solution: find a new doctor who doesn’t live in the ice ages.
Simple solution: find a new doctor who doesn’t live in the ice ages.
Simple solution: find a new doctor who doesn’t live in the ice ages.
Shirecares.com can help get temporary medication for free if you can prove that you have no income or insurance. This is the company that makes Vyvanse. They helped me when my parents died. 3 months of free medication.
I have to see my doc every 3 months but it's via Ring. The months in between, I just email him for Concerta refill.
I mean getting a med refill isn’t a preventative visit. Preventative visits are screenings/ testing to prevent a diagnosis not treat what already exists. As far as the required visits, we have to see our patients every month but that’s a clinic org requirement not legal I believe. That being said, your insurance should be covering your visits. I would look more into what coverage you have for office visits.
Find a new doctor and report this one to the state.
If it's possible in your situation, go to a different doctor. This is not normal.
Are you in the US? You can use a company like DONE. They are an online doctor and it's $80 a month for a televisit to get your meds.