Questions about monthly Rx & your Dr.

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    • #194526
      AWilliams00
      Participant

      Wonder if you can share your thoughts on this.

      I am 60 years old. about 4 years I was tested and diagnosed with ADD.

      Working with a psychiatrist, I found the best results with Vyvanse.

      Over time, the time between appointments grew as we saw that there weren’t any issues with my being on Vyvanse. I wound up seeing the doctor every 6 months for the last 2+ years. Each time I had a visit, I would pay a copay and the doctor would submit a claim for the visit.

      In between visits, (as he instructed me to do) I would call his office and ask for a new prescription for Vyvanse. The pharmacy would say it’s ready and I’d get it. There would be no copay to the doctor and he didn’t submit a claim to write the prescription for those 5 months between visits.

      Is that how it normally works?

      1) After some amount of time, what’s the time between your visits with your prescribing doctor? Is 6 months too long? Too Short?
      2) Does your doctor submit a claim / do you have a copay for the months you don’t see him but he IS writing a prescription (I realize there IS some amount of time / effort for his office to do that.

      The reason I ask is because this doctor died April 2020 due to covid. I found another provider and he got my records from the first doctor’s office.

      Even now, after almost a year under his ‘care’, This provider balks when I ask about seeing him less often than 1x a month (they are video sessions so the time involved is not much, but it’s the copays that add up.

      A couple times I have gotten him to skip a month of a video session. He still submits and gets paid for claims with the insurance company. But he doesn’t have me pay a copay. And interestingly, the EOBs say I have a zero copay sometimes (not an exact correlation – no visit doesn’t always correspond to no copay).

      Could anyone share info on this? How often do you see your doctor after you / he are seeing good results with the med and dose you are on?

      And you still call in for monthly prescription?

      Do you get charged a copay for the prescription?

      Does the provider bill insurance for the prescription writing?

      I don’t know what the ‘norm’ is. I am on cholesterol meds. I see my cardiologist every year now. I realize Vyvance / Schedule II drugs are different / tighter control. But I know how it helps me and affects me. seeing this provider (a psychiatric nurse practitioner) every month seems like a money trough for him.

      But at the same time, I DO realize there’s a cost / labor time each month to write the Rx (which is most of the visit – him typing on his PC after he asks ‘how are you’.).

      Are providers entitiled to be reimbursed for that time to write the Rx? He IS billing them / getting paid for it. But wants my $50 copay each month for the visit.

      He basically said about the monthly visits that he has costs and needs to cover them. (not anything about evaluating my health, etc.).

      Thanks!!

    • #194602
      Penny Williams
      Keymaster

      Doctors are different. Some are less cautious than others. Most want to see a patient at least every 3 months when they are on a stimulant. They can certainly charge you for writing the prescription without an office visit.

      If the monthly visits are only about him making enough money every month, then it may be time to find another new clinician. The visits should always be about checking in with you regarding medication and mental health.

      Penny
      ADDitude Community Moderator, Parenting ADHD Coach, Podcaster & Author, Mom to teen w/ ADHD, LDs, and autism

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