Suboxone Clinic: New Fee Schedule effective October 1, 2016
|Initial enrollment+induction||$325 + $25|
|Initial enrollment (transfer)||$275|
|Follow-up visit (for patients on 12mg/day)||$145|
|Follow-up visit (for patients on 8mg/day)||$95|
|Follow-up visit, 4mg/day or less||$95|
|Urine drug screen||*Included in fee|
|Repeat/Urine drug screen||$25|
|Preauthorization for prescriptions etc.||NA. Service not provided|
Initial enrollment + Induction
This is required for patients who have never been prescribed Suboxone, and for those who are transitioning from Methadone.
It is also available as an option for patients who request it. For example patients who are coming off high dose opioids, or those who have been using long acting or delayed release opioids like Oxycontin, MS-Contin, Opana-ER, Fentanyl dermal patch, etc.
These patients find it difficult to go through the 24 to 72 hrs of opioid free interval required to reduce the amounts of opioids in their body, so as to reduce the risk of precipitated withdrawal when initiating treatment with Suboxone.
This is normally a two day process.
On the first day you present to the clinic for enrollment and medical examination. The process involves reading and completing consents and providing medical and substance use history followed by a medical examination and discussion.
You do not have to be in withdrawal for this step, … but you should not be under the influence either. This takes one and half to two hours. You are given a prescription for Benzodiazepine and Clonidine for one to three days with instructions to abstain from any further use of opioids.
Benzodiazepines and Clonidine will attenuate the withdrawal symptoms that you will experience once you stop using opioids. Benzodiazepine reduces anxiety and provides sedation to help you sleep in spite of withdrawal. Withdrawal is also likely to increase your heart rate and blood pressure, and that is what Clonidine is for. Not everyone requiress Clonidine, but it is there if you need it.
On the second day you will be checked for withdrawal symptoms and given a prescription for Buprenorphine for in-office induction. You will take it to the nearest pharmacy and bring back the medication. You will take the first dose in the clinic, and will be observed for 20 to 30 minutes. If you have abstained from opioids then you will start feeling better within 10 to 20 minutes and will feel almost normal in an hour.
Patients are then provided a prescription for 30 days and a follow up appointment is made in three weeks.
Initial enrollment (Transfer or Initiating treatment after relapse)
This is a one day process. Patients who have been prescribed Suboxone or other Buprenorphine preparation before are not offered induction unless requested. The enrollment and medical examination is completed the same day. It takes about one to two hours.
This requires reading and completing consents, providing a medical and substance use history followed by a medical exam and discussion. Patients are then provided a prescription for 30 days and a follow up appointment is made in three weeks.
Unless you have relapsed and are taking Methadone, high doses of opioids, or long acting opioids you can do without the induction process.
If you are restarting treatment after a relapse then you are required to be in withdrawal to receive a prescription.
If you are transferring from another practice and are already on Suboxone then you do not have to be in withdrawal.
Induction is required for all patients who have never been prescribed Suboxone.
Induction is not required for patients who have had inpatient detox, and have been prescribed Suboxone before.
Patients need to be in withdrawal to receive a prescription.
Patients who are on Suboxone will not be in withdrawal. Their Urine Drug Screen must be negative for opioids to receive a prescription.
My practice does not have a licensed counselor. Patients are free to enroll with a licensed counselor of their choice, and follow the counselors lesson plans.
Patients are required to download a free workbook and follow the lesson plans. There are several books to chose from. There are links (under resources) to sites from where patients can download these workbooks. Patients are given handouts from time to time as supplemental reading and reflection.
Patients are required to be seen once a month. Patients who have tapered their dose to 4mg/day or less, are allowed to follow up as needed.
Current medication dosage protocol.
Patients are started at 16mg/day for the first month, then 12mg/day for three to twelve months. Most patients are able to taper their dose to 8mg/day within three to six months.
Maintenance dose in my clinic is 8mg/day or less. Patients who do not demonstrate satisfactory progress are advised to enroll with an addiction specialist for ongoing treatment.
As you make progress and taper your dose … the total cost of your treatment decreases.
Fees are payable at the time of service. Fees cover the medical evaluation and management by the provider, and do not cover medications, or lab tests.
I no longer participate in any insurance program, private or government funded. If you do have insurance, then it is better to receive services through your network provider. Your insurance carrier should be able to assist you in locating a provider.
Your prescriptions may be covered by your insurance or your prescription plan. You have to check with them as to the conditions for coverage. Typically there is a limitation to the dose and duration for which it is covered. The program may require that you attend counseling regularly to be eligible for the prescriptions. Some programs will not cover the prescription if it was prescribed by an out of network provider.
I will do the needful if you bring a completed pre-authorization form. I am not willing to call your insurance/prescription plan.
I am not a provider for any insurance. Patients who wish to file their own claims for reimbursement should inquire from their insurance carrier the correct procedure to do so. They should bring the necessary forms with them, and I will do my part. I will not be able to provide any burdensome or extensive documentation. It is best that you go to your insurance doctor.
Medicare and Tenncare has been privatized in Tennessee. These are offered by various insurance companies, under fancy names that keeps changing every year. I am not willing to keep up with them. It is your insurance … you deal with them.
My fee schedule is designed for self-pay patients who need to have a predictable fee, so that they can plan for it. There is no separate charge for urine drug screen. The urine drug screen is done at random and the cost is averaged out.
For patients who are filing their own claim, the bill will reflect the actual procedures for that day, and urine drug screens will be charged separately at $25. You need to inform me at the time of enrollment.
If you insurance rejects your claim, I will not be arguing with them … get your own lawyer.
Any claim or pre-authorization that is submitted to insurance carrier, or prescription plan, carries the diagnosis code … your diagnosis code will reflect the substance abuse disorder as per ICD-10. If you don’t want your insurance to know of your addiction problems then don’t file that claim.
The common diagnosis codes assigned are 11.20 for opioid dependence uncomplicated, and 10.20 for alcohol dependence uncomplicated. I do not see complicated cases.
These tests are to be done through your Primary Care Provider. These are routine tests and are usually covered by your insurance.
On initiation, and once a year if indicated:
- A comprehensive metabolic profile (CHEM-7) is required once a year. It includes basic liver and renal function tests, and is done on a blood sample.
- Electrocardiogram (EKG).
These were most likely done by your PCP on enrollment … please bring a copy of the report. It is also done a few months after initiating Suboxone therapy to check for any elevation of liver enzymes.
Male patients should also get their Testosterone level checked, and if low, should seek replacement therapy through their PCP. Long term use of opioids interferes with Testosterone production and results in lower blood levels. Replacement therapy is available to raise your testosterone level to normal range.
Payment at the time of service is accepted as cash or money order. I do not yet have the facility to process debit/credit cards or electronic checks.
My self-pay programs are only for patients who are uninsured, or have commercial insurance but do not need to file claims. Patients who have government funded insurance can not be accepted as self-pay patients.
If you have insurance coverage:
Insurance benefits depend on your insurance policy. Your doctor has not read your policy, … and is not willing to read it. Your benefits keep changing at the whim of your insurance carrier, and there are unwritten and undisclosed limits to your benefits. Your doctor has no idea as to what benefits you have used up, and what is still left there.
Your insurance carrier offers several plans, each with a different policy. Your doctor has no way of knowing which policy covers what, and what is the rate of reimbursement. I do not have the resources or time to deal with your insurance carrier. It is your insurance … you deal with it.
I will not be able to assist you in filing your claims, other than providing you a receipt for payment received and details of service provided.
Cost of Suboxone … it varies from $8 to $10 for each 8mg tablet/film so please ask around, some pharmacies may honor discount cards. Most pharmacies allow you to obtain a partial fill of your prescription. For example you may obtain three to seven days supply at a time, thus reduce your upfront treatment cost.
Zubsolv and Bunavail are similar medications, and for equivalent dose … they cost the same as Suboxone.
All manufacturers provide discount coupon through their websites.
I do not dispense any medication.
You receive a prescription for 30 days that you can take to any pharmacy of your choice and have the medications dispensed to you. You do not have to buy the entire prescription at one time. You can pay for and get a part of the prescription. Please ask your pharmacy about it.
Emergency Prescriptions are provided only when I am in the clinic. Please look at the clinic dates.
It is provided to those patients whose provider has had an emergency and will not be able to provide a prescription before the patient’s current prescription runs out. I should be able to confirm the emergency. You must provide your doctors name, phone, and fax number. You must provide a copy of your last prescription or your prescription package given to you by your pharmacy. There are additional conditions, please call.
Emergency Prescriptions are also provided to patients who came to Tennessee from another state and were held back due to some emergency, or will not be able to get back before their prescription runs out.
Your existing doctor will be able to call in an emergency prescription for few days, enough to carry you through till you get back. The pharmacy may not accept out of state prescription. If you were getting medications from a national chain pharmacy like CVS or Walgreens then they are more likely to accept it.
Get help … treat your addiction … Suboxone is very effective in preventing withdrawal symptoms.
Even though treatment is expensive … it is cheaper than buying illicit drugs … and you will be on your way to recovery.