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Struggling with Insurance/Dr/Meds in MA

BTV65 profile image
11 Replies

15 years, no issues. No trouble finding a Psychiatrist, when he retired my PCP simply took over continuing my prescriptions. It was going great...

My PCP changed practices, the new practice wouldn't take my insurance. The old practice prescribed enough to keep me going until the end of the year when I could change insurance. So I changed to something the new practice took. I checked with them, I checked with the insurance, it was all good. New year starts, book an appt and... no good. Dr is limited in how many patients she can take with my insurance. So she is full. Need a new PCP. That was an awful mess, back and forth with insurance. No one is taking new patients, or they are "full" just like my old PCP. I finally find one. First appt is 6 months out. I book it, but also ask about my meds. She can prescribe normal meds, but not my ADD meds. I need to find a psychiatrist for that.

Psychiatrists are just as bad. Insurance website is horribly out of date. Dr listed there sometimes haven't worked at the listed practice in years. I call place after place. I'm finally pointed at a place taking new patients, go through the process to register then I'm told their office won't prescribe adderall at my dosage (XR 30mg). 20mg is their limit. They will work with me to wean me down to 20mg while monitoring my symptoms... I tried 20mg years ago it didn't work. I've been at 30 for over a decade.

Ugh. Why is this so difficult??? I'm already annoyed that I need to find a different Dr just for these meds. If it hadn't been such a huge struggle just to hunt down a PCP in the first place, I would happily drop this new one to find one who could prescribe the medication. Maybe I just need to start over looking for a different PCP.

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BTV65
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11 Replies
BlessedLady profile image
BlessedLady

Unfortunately, it seems stimulants are the new opiates. Do you have Medicaid ? The reason I ask is I have heard this before and the patient always had Medicaid or Medicare

BTV65 profile image
BTV65 in reply to BlessedLady

No. Here in MA if you don't have employer based insurance then you go to a state "Health Connector", where it allows you to look at a variety of insurers and plans to pick one that fits your budget and needs. You pay your monthly bill through the health connector as well. My household income is pretty high, so I'm paying 100% of the cost. No subsidies from the government.

Yes, I could buy my insurance directly but I would have no way to easily compare plan costs/benefits, etc. The Health Connector is very convenient and easy to use and it wasn't until my PCP changed practices did I run into these issues.

BlessedLady profile image
BlessedLady in reply to BTV65

Unfortunately, it sounds like you will have to pay out of pocket to see a psychiatrist. Expect to have to go through being tested. There is no guarantee another doctor will prescribe the same medication or the same dose as your previous doctor.

BTV65 profile image
BTV65 in reply to BlessedLady

What kills me is that PCPs in this state are allowed to prescribe the meds. A local system even said that their Psychiatrists can take a single visit patient from a PCP in the same system so that the PCP can then prescribe the meds. It's just that the one I found won't do that and instead is telling me to find a psychiatrist on my own.

BlessedLady profile image
BlessedLady in reply to BTV65

Any PCP can legally prescribe Schedule II drugs . Provided they have their CDS and DEA numbers. It is up to each doctor or each group what they prescribe and what is required. That is one of the reasons I said stimulants are the new opiates. I remember when PCP's prescribed opiates with no problem. Now not as many will. The best thing you can do is pay out of pocket for a psychiatrist. It will be expensive because they will want to test you. You won't have any guarantee they will prescribe what you have been taking it the dosage. But I think it is a chance you will have to take. You could get lucky

Adhdhelpme profile image
Adhdhelpme in reply to BTV65

Same here in WA state. PCP can't prescribe meds because of other psychotropic meds. Says i need a psychiatrist. I can't even find one that will see me.

soysauceisawesome profile image
soysauceisawesome in reply to Adhdhelpme

Actually this is not accurate. I live in Washington state and my PCP has been prescribing my ADD meds for the last 20 years. I know there are other doctors in my PCP's practice that choose not to prescribe them and make you go to a psychiatrist.

PhillySail profile image
PhillySail

Welp I've been surviving with online telehealth services, availability varies state to state, and may be sunsetting soon, but look into it, the FDA is supposed to issue rulemaking on telehealth in the coming day... In my case I have the XR and standard prescribed at 20mg, not the standard is my "backup" when the XR wears off and I need a little extra. so technically I'm not above 20, but actually Somedays I am....

MrQuest profile image
MrQuest in reply to PhillySail

I've had to do the same thing. Be sure to call and check all online options. I've heard some are good and some not so good.

I was surprised to have access to psychiatrists on Teledoc via my previous employer. Sadly that disappeared when I switched employers. My new employer covers Teladoc, but not for mental health. Suddenly I had zero access to any online psychiatrists, even the one I had been previously using. I couldn't even pay out of pocket because the employer plan determines what's listed in the app.

Currently stuck with Lyra because of my employer. MDs only for mental health prescriptions 😞 and not clear if they can prescribe stimulants or not. The online MD has been very supportive though and directed me to ND doctors in my area that might be able to help me get re-diagnosed.

BTV65 profile image
BTV65 in reply to PhillySail

I'm going to try and re-visit the online option and talk to a nurse practitioner. I said no to that option yesterday, then spent the day failing to find any other workable option, so I'm circling back to that one.

About seven years ago, after my psychiatrist relocated across the country, I could not find a psychiatrist who took insurance who was taking new patients. And I was thorough and obsessive.

Ended up finding a nurse practitioner and she is excellent, as good as any of the psychiatrists I've seen and I feel more connected with her.

Don't know if this is relevant, but I live in Pennsylvania, but my metro area includes parts of New Jersey. So I go to Jersey to see the nurse practitioner (actually now we do calls). So if you are anywhere near the border with another state, you might check and see if there are practitioners there you can use.

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