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What Happens if You Can't Afford Methadone Anymore?

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  • What Happens if You Can't Afford Methadone Anymore?

    This is a concern that I have...even the best Methadone clinics require payment for their services. There is nothing wrong with this as money is required to keep any program running. However, what do some of the ethical and best Methadone clinics do if a patient of theirs loses their job (or insurance) and can no longer afford to pay? I will say upfront that anyone who loses their job should begin immediately looking for another and eventually I'm sure the money issue will be resolved. But will clinics work with their patients? What happens when the going gets tough?

    ​In my opinion, not allowing someone to dose should NOT be an option. People depend on their medication and even though withdrawal from heroin, methadone and other opiates won't kill you, they will likely experience horrible withdrawal and in some cases, may cause someone to make the choice to go back to using heroin, all to avoid withdrawal. Thus, in my opinion, it is horribly irresponsible for Methadone clinics not to continue medicating their patients even if/when money becomes an issue.

    I realize this is a complicated issue because anyone could say they don't have the money and Methadone clinics (like any treatment center) needs money to exist and function. However, sometimes shit happens and people literally don't have the money for a short period of time between jobs or until insurance kicks in, etc. So what do the good Methadone clinics do?

    I would love to get people's input on this.

    Peace and Love,

    William


    Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers.

    Find a Prescreened Addiction Treatment Center & Drug Rehab Facility

    Visit our Heroin Addiction & Recovery Blog for daily articles.

    I do my best to educate myself regarding addiction and recovery related issue, treatment options, etc. however, I am not a medical professional. All opinions are my own and any advice you take from me is at your own risk and discretion

  • #2
    William,
    . The Methadone clinic I was at wouldn't dose you unless you had the $15.00. They used to let people "charge" but then people took advantage of that as they racked up a high bill & left. Then they tried a "MSW" Medication Supervised Withdrawal & you would have to go down 5 mg every day that you didn't have money. They stopped that as well. So now you cannot charge whatsoever. Only if your pregnant. After you have the baby you have so many months to pay your debt & if you don't, they kick you out. I've never been pregnant on any drug but I did have friends that was kicked out of the clinic due to an outstanding debt. Hope this helps!

    Comment


    • #3
      I understand that methadone clinics need to get paid in order to run and operate. But, I do think that withholding someone's medication when they rely on it shouldn't be an option. I do think that something needs to be done, I do think that people who enroll in the program need to be responsible for their obligations which includes their financial ones however, sometimes, people do get down on their luck and I believe that clinic should work with these people. It's a catch 22 though I guess. Anytime a clinic becomes lenient, someone takes advantage of it and ruins it for the masses.
      Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers.

      Find a Prescreened Addiction Treatment Center & Drug Rehab Facility

      Visit our Heroin Addiction & Recovery Blog for daily articles.

      I do my best to educate myself regarding addiction and recovery related issue, treatment options, etc. however, I am not a medical professional. All opinions are my own and any advice you take from me is at your own risk and discretion

      Comment


      • #4
        Thats exactly right. When you go to intake you do sign a contract with the clinic for the financial obligation. I do agree that if you've been there for more than 6 months & loose a job, waiting for insurance to kick in they should still help you even if they have to cut your dose in half. How can we go about changing this?

        Comment


        • #5
          The thought of this is scary. Very true about Suboxone too.

          Comment


          • #6
            Originally posted by William - Publisher of this Community View Post
            This is a concern that I have...even the best Methadone clinics require payment for their services. There is nothing wrong with this as money is required to keep any program running. However, what do some of the ethical and best Methadone clinics do if a patient of theirs loses their job (or insurance) and can no longer afford to pay? I will say upfront that anyone who loses their job should begin immediately looking for another and eventually I'm sure the money issue will be resolved. But will clinics work with their patients? What happens when the going gets tough?

            ​In my opinion, not allowing someone to dose should NOT be an option. People depend on their medication and even though withdrawal from heroin, methadone and other opiates won't kill you, they will likely experience horrible withdrawal and in some cases, may cause someone to make the choice to go back to using heroin, all to avoid withdrawal. Thus, in my opinion, it is horribly irresponsible for Methadone clinics not to continue medicating their patients even if/when money becomes an issue.

            I realize this is a complicated issue because anyone could say they don't have the money and Methadone clinics (like any treatment center) needs money to exist and function. However, sometimes shit happens and people literally don't have the money for a short period of time between jobs or until insurance kicks in, etc. So what do the good Methadone clinics do?

            I would love to get people's input on this.

            Peace and Love,

            William

            Well your right this happens BUT many states have FREE state insurance and it covers it. What state are you in???? I can give you info on what's available. All I can say is when working its so so so important to plan for possibilities. So even saving small amounts for times like this is so important because I would rather die then withdraw. It's that bad for me yes I'm a big baby. But plan , plan ,plan is all I can say also the first thing you should do is research what your state offers they do have programs that help MA is a state that pays everything and even pays to get you there. If I HAD to i think I would move for this option IF it got that bad. Saving your life is this important. I hope this helps a bit.

            Comment


            • #7
              hairless,

              Thank you for your response and welcome to our heroin addiction and recovery discussion forum. I live in the state of PA. I have interviewed a few methadone clinics and some seem to work with their patients more than others. Many of the publicly funded methadone clinics have someone that work with the patient and help them signup for the insurance when it expire. If they are not eligible for insurance, many of them do offer a pay out of pocket system and even though they don't offer that to people on the outside, they offer it to their already existing patients just to try to work with them. But if they can't afford it, they typically administer a rapid detox and send them on their way.

              Privately funded clinics, at least the one I interviewed tries to work with their patients as well. They provide payment plans, they let them fall behind with promises that they will make up the payments and remain patient for awhile until the patient either a) gets back on their feet and can resume payments or b) continues to fall further and further behind with no sign of even applying for jobs, etc. in which case they also administer a rapid detox and let the patient go.

              The methadone clinic I interviewed admits it's a real difficult situation and only typically lets someone go when they have a good sense that the patient is trying to take advantage of their patience and just trying to get dosed for free without showing any evidence of getting back on their feet anytime soon.

              While I do feel that there should be more programs for people who genuinely need treatment, part of treatment and recovery is about learning to become independent, work and be responsible and accountable for your actions. Paying for services/treatment is part of being responsible. After all, addicts seem to always find money to pay for their drugs, they can certainly learn to be responsible and pay for treatment. On the flip side, there are just some people with a heavy rain cloud over their heads who desperately need help and would do anything, including work their ass off if they had the opportunity but just can't find anything. Those are the people who I believe should be helped with financial benefit programs.

              Peace and Love,

              William
              Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers.

              Find a Prescreened Addiction Treatment Center & Drug Rehab Facility

              Visit our Heroin Addiction & Recovery Blog for daily articles.

              I do my best to educate myself regarding addiction and recovery related issue, treatment options, etc. however, I am not a medical professional. All opinions are my own and any advice you take from me is at your own risk and discretion

              Comment


              • hairladies3
                hairladies3 commented
                Editing a comment
                Wow.. PERFECTLY said.. I totally agree. I see big time abuse of the system and it pisses me off to be frank. I work 2 jobs to make ends meet. It's hard but becoming responsible is NUMBER ONE on the list. Love the way you wrote that. You should write a book...lol

            • #8
              hairladies,

              It makes me upset and angry too Too many people abuse the system when they could actually afford thing and then there's not enough resources available for those who actually need it.

              And thanks for the compliment lol. I've thought about writing a book but I don't have a lot of time. I do write a lot of blogs though. Feel free to our heroin addiction and recovery blog and news site.

              Peace and love,

              William
              Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers.

              Find a Prescreened Addiction Treatment Center & Drug Rehab Facility

              Visit our Heroin Addiction & Recovery Blog for daily articles.

              I do my best to educate myself regarding addiction and recovery related issue, treatment options, etc. however, I am not a medical professional. All opinions are my own and any advice you take from me is at your own risk and discretion

              Comment


              • #9
                This is such a difficult issue. The clinic I attend (NJ) requires you pay weekly, or bi-weekly if you are at the 13 takehome phase. If you cannot or do not pay, you can not dose that day. If you can't pay the next day, they will let you dose but they decrease it by 5 milligrams everyday until you pay. If it becomes evident that you are not going to pay or if they are kicking you out for other reasons, suh as breaking clinic rules, they put you on fee-tox. They take your dose, divide it by 21 days and decrease it so you are down to zero on day 21.

                I understand that people sometimes struggle and have things like job loss happen. If you have been a patient in good standing, abidiny all program and financial requirements, there is a chance they will give you a week or two extension. That is the exception rather than the rule.

                There should be some sort of protection in case of financial hardship. There are many patients who are on Medicaid (state insurance for the poor) and it pays all of their clinic fees AND pays for transportation to and from the clinic. It is great that it is covered, but I have to be honest..it creams my corn that I pay for private health insurance (through my husbands employer) and it isn't covered. Even if it was, my clinic does not accept it. It is medicaid or cash. Guess who pays cash?

                I understand that they need to be paid for their services and that in this country we pay for healthcare. However, in the case of MMT, I think their needs to be some protections put in place for extreme situations such as sudden or prolonged job loss, death in the family, illness etc. Other than these extreme situations, I feel we shoulld pay for treatment. We could always get money for drugs...we should put that much effort and ingenuity into our recovery!

                I hear a lot of complaining about fees in the clinic line. The one I hear the most is "methadone is so cheap! We are getting ripped off!" While it is true that methadone is a very inexpensive medication, fees also have to cover rent, insurance (property and liability, plus malpractice for the clinic doctor and nurses), salaries of counselors, nurses and other staff, lab testing fees and the mundane like electric, water and toilet paper. Not to mention computer equipment, office supplies and the like. The heavy regulations involved in operating a clinic leads to an abundance of paperwork and overtime pay for staff. It is an expensive proposition to run and we get the burden of paying for it.

                I actually think even Medicaid patients should have to pay for a portion of their treatment and here is why. I think when you take responsibility for your treatment and have to pay for it, it means a little more to you. Any time you work for something in life, you have a vested interest in making it work and doing your best. I think it is the same with recovery. I know some people are really struggling, but even having to contribute $5.00 can make it seem a little more important and can do a lot with the gratitude factor!
                Last edited by lolleedee; 11-29-2016, 12:12 AM. Reason: lots and lots of typos!!!

                Comment


                • #10
                  Lolleedee,

                  ​Thank you for sharing some of your thoughts on this very difficult issue. For starters, I can relate to where you're coming from. As someone who has a job and private insurance, I have to pay for my private methadone clinic every week. I pay 120 a week which adds up to $480 a month. That's the cost of a pretty nice car payment, even if you put nothing down - more specifically a $24000 car with a 0 down-payment. Every $5000 is about $100 finances...yes, I'm a math geek, or a car geek or a programming geek - maybe all 3 :-). But that said, it's very frustrating watching people get their methadone for free every day, especially people abusing it and doing benzodiazepines on the side without ever seemingly getting kicked out.

                  ​What you said about how your clinic handles non-payment is wrong in my opinion. Not being able to pay for 1 day should not result in not being able to dose that day. My clinic is MUCH more reasonable with that. Typically we are supposed to pay every Monday but they usually ask "When is the next time you will be making a payment", which is a very nice way to ask considering payment is supposed to be due that day. Now, with only a few exceptions, I paid every Monday. Now that I have 3 take-homes (pretty much the maximum at my clinic unless you've been there for years), I pay on Wednesday, my first day back there. That said, SO many people are behind on payment and my clinic really does a great job working with people to try and help them out. At some point, they do take punitive action but it does take awhile.

                  ​I think my clinic has the right idea, though I think sometimes they may be TOO lenient. Some people clearly take advantage of their generosity so I always make sure I pay on time.

                  ​That said, people who clearly are doing well in the program who fall on difficult times could benefit from what my clinic does. Taking their medication away promptly is almost as bad as putting a bag of heroin in their hands. Most people really dread the possibility of not getting dosed. Most people can make it through a day or two, especially at higher doses. Me, I'm now on 18 mg, so I likely couldn't make it more than 24 hours. But that's true of anyone who is tapering.

                  Always great to see your feedback and contributions :-).

                  ​Peace and Love,

                  William
                  Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers.

                  Find a Prescreened Addiction Treatment Center & Drug Rehab Facility

                  Visit our Heroin Addiction & Recovery Blog for daily articles.

                  I do my best to educate myself regarding addiction and recovery related issue, treatment options, etc. however, I am not a medical professional. All opinions are my own and any advice you take from me is at your own risk and discretion

                  Comment


                  • #11
                    They are very harsh with payments! Their policies have evolved over time and I think the reason they are so strict is because, unfortunately, people were taking advantage of the lenient payment options that used to exist.
                    I can see it from both sides. I think people should have access to the medicine they need. However, in this country we pay for healthcare, and I believe that MMT falls into "healthcare". That said, I think it should be MANDATORY for private insurance companies to pay for it (I believe Medicaid covers it in every state..not certain though.) If patients don't have private insurance and do not qualify for Medicaid, there should be a program in place to subsidize those patients. In a perfect world we could do away with "cash pay".

                    The huge problem with MAT, is that it is healthcare that is so far removed from mainstream medicine. That HAS to stop!! I thought with the passing of the Parity act (MHPAEA-Mental Health Parity and Addiction Equity Act) that reimbursements would be better, but it has had minimal impact!

                    Like I said, I see it from both sides. It is important that people have the medicine they need to recover and money shouldn't be an obstacle to recovery. Unfortunately, that doesn't jive with the U.S. healthcare system as it now exists. I think we have to work on getting better reimbursements, forcing insurance companies to pay for MMT and finding some way to finance those who do not have private insurance or medicaid.

                    The last thing I would want is for people who are on MMT to have to choose between food and treatment. MMT is about getting your life back..it shouldn't put you in the poor house!
                    Last edited by lolleedee; 12-02-2016, 06:35 PM.

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                    • #12
                      Clinics shouldn't stop people from getting their methadone. They're dependent on it. They should work with their patient.

                      Comment


                      • #13
                        I agree CannibisRules, I understand that treatment, much like everything else in life is "pay to play" but I think its inexcusable for them to cut people off knowing exactly what the consequences could be.
                        I am the Editor and Forum Co-Moderator for Kill The Heroin Epidemic Nationwide and Heroin News.

                        All opinions are my own and don't necessarily represent that of Kill the Heroin Epidemic Nationwide. I am not a medical professional and nothing I say should constitute or replace medical advice provided by a professional.

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                        • #14
                          Thank Goodness my clinic started me on the government grant that they got.I couldn't afford it after Medicaid expired, so I missed like 9 days, well then the owner told me that he would put me on the grant but they had to dismiss me through the computer so on the 12 day I was labeled as a intake, even though I have been there for almost 2 yrs, and put on the Grant. So now I don't have to pay!!!

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                          • #15
                            The bottom line: there are individuals who taper from methadone, and do this successfully, initially. Nevertheless, the huge majority--over 80 percent --relapse.
                            Opioid treatment programs (OTPs), as with other doctors, aren't needed to give patient care with no charge. If a patient can not cover, and has no insurance and no Medicaid policy, the OTP can--humanely--draw the individual from methadone. Buy here

                            When a patient would not pay or agree to a payment plan after passing obligations for fourteen days, CODAC would start methadone withdrawal. This gave patients six months of"free therapy," four of these spent withdrawing from methadone. Sometimes, patients could stop this procedure if they met their payment conditions.
                            There was a bunch of self-paying sufferers before this ACA--individuals who did not qualify for"subsidized" treatment due to their earnings exceeded established limits, they left a lot of money for Medicaid, or apps had reached their limit onto subsidized capacity. But today everybody has improved accessibility to medical insurance. "Happily, monetary withdrawals are getting to be rare because of Medicaid growth," explained Mr. Rizzi of administrative refunds for financial motives.
                            For individuals who self-pay, this can be a $4,500 annually out-of-pocket expense. In the years prior to the ACA, whenever someone was not able to cover, most apps would produce a payment plan, said Mr. Rizzi. "If patients dropped behind--missed a couple of months --we'd work out a weekly payment plan letting them pay down exactly what they owed more than time. The opioid therapy providers recognize this isn't a simple life-change," he stated, of withdrawing from methadone. "we would like to help patients remain in therapy in a means which isn't financially burdensome."

                            But she noticed that unlike general medical clinic, many OTPs--until recently--did rely on getting patients pay for their treatment. "There has been an increase in insurance policy, because of the Affordable Care Act [ACA], and it is our expectation that'll bring less demand for administrative withdrawal."

                            Some individuals might not know that even though methadone itself is cheap, they are paying to get a good deal longer when they visit an OTP, '' said Ms. Crowley. OTPs, so as to be accredited and licensed, have to supply services like counselling. "Unlimited doctor visits, individual and group counselling --infinite if necessary--aren't optional. Can you visit a psychologist or a psychologist three times every week, should you will need to, to get $15 to $17 per day?"

                            In Rhode Island, in which Medicaid was enlarged, administrative refunds have become a thing of the past. For individuals that are self-pay--that some still decide to be, particularly if they have commercial insurance but do not need to have the payer to understand they're in therapy --the potential for a"fiscal withdrawal" exists.
                            In Tennessee, in which no more public money is invested for methadone within an OTP--maybe not Medicaid capital, not the block --each OTP has its own rules to attempt and aid the individual pay, stated Ms. Crowleysaid "The main point is, even if they can not pay, we can not carry them long term."

                            There are individuals that aren't insured by unexpanded Medicaid--for example adults with no dependent children--and the majority of them are self-pay, stated Mr. Connell. If individuals are pregnant, then OTPs treat them irrespective of their capacity to cover. For additional patients, Personal Clinic includes a"helping hands" program, under which bucks are designated to assist patients.
                            "Our expectation is they will do everything possible to attract up that patient to rate fiscally," Dr. Campopiano informed AT Forum. "But when they can't do this, we hope they will use a medically efficient and appropriate withdrawal interval." Based on the present dose of methadone, this could be provided 21 days, and maybe longer, she explained.
                            For many new OTP patients, the costs of therapy are much less compared to the amount that they were spending on medication, stated Mr. Connell. "The ordinary man we see was spending 100 to $400 per day on medication. If they come to us and invest $12 per day, they view it as a savings program " But what Mr. Connell has heard after 16 years at the OTP area is the longer someone remains in therapy, the tougher it's for them to cover. "The number-one reason people leave remedy is cash," he explained. "it is a really challenging issue."
                            Whenever there's administrative withdrawal, patients must receive naloxone in the event of relapse, and when you are able, naltrexone, either the elongated release version (Vivitrol), based on SAMHSA.
                            "When they lost their job, and have been engaging and actively operating in the app, we'll lower their fees. For somebody who's really on a fixed income, for example welfare, we might decrease their charges for a time."

                            Ms. Crowley explained that CARF-accredited OTPs should provide patients warnings to three other applications in which they could get therapy, but noticed that those apps aren't required to select the individual. "It is up to the individual to follow ," she explained.

                            Georgia

                            OTPs at Georgia, which failed to expand Medicaid, do not have a position on credits. AT Forum talked with Jonathon P. Connell, Who's chief executive officer of Personal Clinic, an OTP established in Albany, and president of Opioid Therapy suppliers of Georgia (OTPG). Talking for his own practice, but not to its OTPG, he also discussed the problem of administrative withdrawal.


                            Crucial parts of the story are Medicaid growth and Medicaid payment for OTP providers --both are state-by-state policies. With this particular story, we spoke with a single nation that expanded Medicaid (Rhode Island), and 2 which did not (Georgia, in which Medicaid will cover OTP providers, and Tennessee, in which Medicaid does not pay individual care in OTPs). We also spoke with national regulators.


                            Reference
                            Tennessee
                            Generally medication, if a doctor will terminate a connection with a patient for any reason, the doctor must offer the individual with 30 days of care if the patient appears to get a new supplier, stated Dr. Campopiano. "We can not hold opioid therapy programs into a higher standard."
                            Excerts in the SAMHSA's certification instructions for OTPs on administrative withdrawal is available in: http://atforum.com/samhsa-guideline-2-9-2016/
                            Occasionally patients who could not pay would try to move to a different supplier in the country --there are just five OTPs at Rhode Island--so would depart one OTP, using an outstanding balance, and proceed into another. "Apps attempt to be inventive, meaning not waiving or forgiving fees, but seeking to allow the individual to see the way to fulfill with the obligation for repayment in as painless a manner as you can," he explained.

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