“Another one of my patients was denied coverage for his buprenorphine treatment because he’s still using marijuana.
I’ve written about this kind of situation before, and I have mixed feelings.
It was time for me to fill out this patient’s prior authorization form, which must be completed every year, before for the insurance company will agree to continue to pay for his Suboxone. Among other questions, the form asked if all the patient’s urine drug screens have been negative for illicit drugs. Much as I personally may be tempted to answer “No” in order to save the patient some aggravation, that would be a lie. I’m not willing to commit insurance fraud, so I answered honestly. In the insurance company’s eyes, this means my patient is noncompliant with treatment.
Last year, we had no problems. I answered all the questions the same as this year, but I suspect insurance company workers inadvertently overlooked my answer. Not this year. We got news that the prior authorization was denied, and I suspected the positive drug screens were the reason.”
Source: Dr. Jana Burson – November 16, 2015