Methadone: A Flicker Of Light In The Dark

Methadone: A Flicker Of Light In The Dark

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 Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification

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lilgirllost
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Number of posts : 863
Age : 44
Location : live in Louisiana but attend MMT clinic in Tx
Job/hobbies : COUPONING & GEOCACHING are my favorite past times but I also love reading and spending time with my husband and kids
Humor : I don't have a sense of humor.............
Registration date : 2009-05-25

PostSubject: Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification   Wed Jul 08, 2009 11:42 pm

I know that the information is readily available on the Internet and if you were given a "HandBook" from your Opiate Treatment Program, I am sure the information was given to you then, too. However, I have recently been contacted by a patient with a question/problem about a situation they managed to find themselves in so I thought it would be a good time to provide us all with a "refresher" on the subject and to see if anyone would like to share their experiences with us.

The problem the client was having was that they owed their clinic $300 and while they couldn't pay it right now, they said they would be able to eventually. Because they owed the money, the clinic started administratively detoxing them by going down 5mg a day. Of course, the client is having trouble and is struggling, and they wonder if there is anything they can do about this situation or who to complain to.

Each Opiate Treatment Program has their own guidelines you must follow on how to handle non-payment and/or late payment. You should have been given a list of their rules when you were admitted on how they deal with the situation......such as how long they will carry your balance before they start detoxing you and/or if they take any kind of payment arrangements to help you pay the money owed them without having to go through detoxing you.
Each one may have different guidelines dealing with Non-payment of Fees. HOWEVER, they are perfectly within the FEDERAL GUIDELINES to administratively start detoxing a client for non-payment of fees. I obtained the information I got directly from SAMHSA at http://www.dpt.samhsa.gov/pdf/OTPAccredGuidelines-2007.pdf and you can also view it by going to our website at:
http://www.medicalassistedtreatment.org/51011/index.html
clicking on the left side link that says FEDERAL REGULATIONS, then go down to the bottom of the page and click the link there and it is on page 21.

Here is what it says about when you can be administratively detoxed.
Administrative Withdrawal and Discharge
[/size][size=12][size=12]A major goal for programs is to retain patients for as long as they can benefit from treatment and express a desire to continue it. Because retaining the patient is not always possible, programs provide procedures for administrative withdrawal that employ the principles involved in medically supervised withdrawal from medication. Administrative withdrawal is usually involuntary. When a program makes the decision administratively to discharge a patient from pharmacotherapy, the program offers a humane schedule of medically supervised withdrawal, using sound clinical judgment. A suggested medically supervised withdrawal schedule for administrative withdrawal is generally a minimum of 30 days, but the physician may adjust this timeframe depending on clinical factors. The program documents the person’s condition during medically supervised withdrawal in the patient’s record. On discharge, the program makes appropriate alternative referrals. Given the short timeframe and poor prognosis for the withdrawal procedure, patient referral or transfer to a suitable alterative treatment program is the preferred approach.
Administrative withdrawal may result from Nonpayment of Fees. Remedies may include referral to a more affordable treatment program. As a last resort, programs provide a humane schedule of medically supervised withdrawal.
Disruptive conduct or behavior. Such behaviors may have an adverse effect on the program, staff, or patient population of such gravity as to justify the involuntary medically supervised withdrawal and discharge of a patient, despite an extremely poor prognosis. Disruptive behaviors include violence, direct threat of violence, dealing drugs, repeated loitering, and flagrant noncompliance, resulting in an observable, negative impact on the program, staff, and other patients. Patients who exhibit disruptive behaviors should receive a mental health evaluation and referral, as appropriate, prior to administrative withdrawal.
Incarceration or other confinement.
The OTP takes into consideration all factors affecting the patient on a case-by-case basis, and documents procedures for any involuntary terminations of patients.
Efforts made regarding referral or transfer of the patient to a suitable alternative treatment program should be documented.
The program makes specific efforts to ensure referrals are followed through to completion for the pregnant patient in the rare event the patient is administratively withdrawn and discharged. Provider(s) should carefully follow up with both patient’s pregnancy and opioid dependency. It may be helpful for the program to establish prearranged agreements for treatment for this very purpose.

So as you can see, an Opiate Treatment Program is well within the Federal Guidelines to institute Administrative Detoxification for nonpayment of fees. It is a sad situation when that happens and we all know that as expensive as fees are now a days, we are just one step away from being someone not able to pay our own fees.

If you find yourself in a situation where you are going to be unable to pay your fees the best thing to do is to refresh yourself with your Opiate Treatment Program rules on this situation and then BE HONEST and UPFRONT about it as soon as you know it is going to be a problem. Sit down and calmly talk with your Program Director or whoever is in charge of this and explain to them what is happening. Try to see if they will work something out so that you can repay them the money you owe them and not have to be administratively detoxed, but again, I wouldn't wait until you are already behind on your fees to bring it up.

We all know that even though we may do these things, there are still Opiate Treatment Programs out there who are not client friendly and no amount of planning, talking or even pleading is going to make them change their mind. In that situation, we can only hope and pray that one day the laws governing for profit programs will change
(?)

I would like to hear about any of your experiences with Administrative Detoxification, whether it was for unpaid fees or another situation so give us a post!


RuthAnn
aka lilgirllost

We are not bad people trying to become good, we are sick people trying to become well.

Methadone; A Flicker Of Light In The Dark
www.medicalassistedtreatment.org
www.suboxoneassistedtreatment.org
We are available 24 hours a day, 7 days a week.
If you cannot afford to call us, send us an email and
we will call you at our expense.
Office: 1-770-334-3655~ Cell: 1-770-527-9119
Email: mrdeanv@aol.com
ALL INFORMATION IS KEPT STRICKLY CONFIDENTIAL
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Registration date : 2009-03-05

PostSubject: Non-Payment Of Fees   Sat Jul 11, 2009 3:21 pm



Ruthann,
Thanks for taking the time to post the Federal Regulations regarding Non-payment Of Fees. I believe we do need to remind the patients they can be discharged for this very reason. Most of the Opiate Treatment Programs in Georgia will only allow you to charge one day's dose. When you return the following day, you must pay for the dose you charged plus the dose you are getting today.
I know it has become very difficult for some of us to pay because of the Recession we are in. It 's not like they really care because methadone is a "Cash Cow." We need to start thinking about our own selves and how we can solve the problems we have. I can tell you things are not going to become easier and jobs are very far and few between. Michael Jackson's death did not help our cause either. It is just going to make medications much more difficult to obtain especially for those of us with pain issues.
I'm surprised He could even find an Opiate Treatment Program to allow Him to charge up to $300.00 but I have heard of some of them allowing patients to charge lately. You just never know when they can pull the plug on you and if yours do allow you to and you need to take advantage of it ...please for your own safety make them put it all in writing as to when you need to have it paid back and have them include they will not discharge you as long as you obey the rules they set forth on paying it back.
What's wrong with all of you -how about sharing and let us know if your Opiate Treatment Program is allowing you to charge? Please do take note if you want to read over the Federal Regulations, she gave you the link to lead you to them and I know its difficult but all of you should be familiar with them. If not...then you should know where to find them if you need to look up something because you can't always count on your counselors to tell you the truth.
I try to pay for my methadone in advance because I realize I can't function without it and it is second on the list after the mortgage payment. It comes before any of my other obligations, even food. I believe Ruthann, our new Moderator has even a better way of paying it -if you can work it out the way she does. Maybe if you ask her how she pays for hers -she will take the time to share with you. I would certainly take the time to write the link down guiding you to the Federal Regulations in case you just may happen to need it.
Your Fearless Leader,
Deborah lol!
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lilgirllost
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Number of posts : 863
Age : 44
Location : live in Louisiana but attend MMT clinic in Tx
Job/hobbies : COUPONING & GEOCACHING are my favorite past times but I also love reading and spending time with my husband and kids
Humor : I don't have a sense of humor.............
Registration date : 2009-05-25

PostSubject: Re: Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification   Sun Jul 12, 2009 1:46 am

I would be more than happy to share how I handle payment of my clinic fees.

Like Deborah said about her priorities, my methadone fees fall as a major priority in the scheme of our budget. I know I am going to be taking it and unless you are lucky to live in an area where you can go to a free clinic,it is expensive and costs as much as a car payment each month.

We usually get a substantial income tax refund back every year and instead of using that money to pay other bills off or splurge on other things (which is would be SO easy to do) we would go ahead and pay my clinic fees up to a year in advance.

Clinics may give you a discount on fees if you do pay in advance (or at least mine did). Mine would give 2 weeks of free treatment for 6 months in advance or 1 month free for a year in advance. The only drawback was my clinic made me sign a form stating I wouldn't get any of the money back that I hadn't used if I left before the time period was up. So it is important to make sure you know you are going to be staying at that clinic and/or continuing MMT for the period of time you are paying in advance for. Not all clinics may have the same rule so be sure you talk to your clinic BEFORE you hand over that money!

It is alot of money but when you figure that takes care of your fees for a year (or 6 months) at a time so you don't have to worry about it, that is an extra $320-$400 a month that you will have each month, plus if your clinic gives you a discount, then you are actually getting 2-4 weeks free treatment, you are actually saving more in the long run.

I know it is a sacrifice to do it this way. I don't know how many times we wanted to use that money for something else! But it gets the fees out of the way, it assures you will get your MMT if something does happen to come up that affects your ability to pay and it keeps you in good payment standing with your clinic because you are already paid up. In the long run, it helps us out better to pay in advance.

Some people may not be able to do it this way and/or it may not work out best for everyone but that is how I deal with it.

I would love to hear from some of you all about how you handle the expense.........


RuthAnn
aka lilgirllost

We are not bad people trying to become good, we are sick people trying to become well.

Methadone; A Flicker Of Light In The Dark
www.medicalassistedtreatment.org
www.suboxoneassistedtreatment.org
We are available 24 hours a day, 7 days a week.
If you cannot afford to call us, send us an email and
we will call you at our expense.
Office: 1-770-334-3655~ Cell: 1-770-527-9119
Email: mrdeanv@aol.com
ALL INFORMATION IS KEPT STRICKLY CONFIDENTIAL
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Registration date : 2009-07-29

PostSubject: Charging at the clinic   Thu Jul 30, 2009 12:26 pm

Again I don't have the problems most of you have with charging and paying. My clinic knows that I am employeed and so is my fiancee. I hate charging but sometimes I must my hardest time is the last week of the month sometimes we pay ahead sometimes day to day. Right now I owe $70 and am not worried at all about dosing he gets paid tomorrow and we will pay it all off on sat. Work has been slow this last few weeks this is the most I have ever owed. Sat my friend told me she was $105 behind but they were not going to e her charge anymore but I also know she doesn't have a job she's 22 and her mom actually gives her roxicotton to sell in order to pay for her methadone how twisted is that?! My clinic charges $13.75 a day for methadone no matter what dose you are at, though suboxone is charged by the amount you take and the max does of 32 mg is like $26.00 a day going down I think 25-32mg is $26 and then 8-14mg is $16 or so I'm not sure from there.
The only complaint have about my clinic is they are unorganized a very inefficient when it comes to getting us in and out. They also changes the rules about what time you are allowed to line up depending on who is watchin the door. I am a priority doser which means Ibrought a letter fom my job stating that somtimes Ihave to be at work early and they give me a card to get in early, there are maybe 30-40 pririty dosers and we have a very short window to get in. We hav to be in the door between 5:45 and 6:00 or we can't get in until 6:30. Yes 15 min window, so a wreck, bad traffic, getting pulled over and you do not get in til 6:30.
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PostSubject: Re: Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification   Mon Aug 10, 2009 3:43 am

i really think Ruthann has a genius idea about paying in advance for methadone fees using an income tax return! especially if you are happy w/ your clinic & know you will be there for a while. i think i'm gonna try it this upcoming tax season! right now i pay for 28 days at a time (i get 28 takehomes). it is a dollar or two cheaper (depending whether you are on liquid or wafers) that way. so i always pay for my whole "month" at once. but i have had to charge once (before i was phased up to 28 days) because i had to pay an unexpected expense the day before clinic. they let me charge my two weeks takehomes on a friday morning & i paid it back on monday after my husband got paid. it was very nice of the administrator to do that for me! i am blessed to not have had to charge again, but you just never know what could happen in these economically uncertain times we are in now. i would be terrified if i couldn't pay for my methadone & feel horrible for people who are being adminstratively discharged because they could not pay. somehow there has got to be a more economical way to help those who cannot afford their medicine. in the long run it would be worth it, less crime, less drugs on the street, productive members of society who hold down jobs & pay taxes, etc., etc.!
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PostSubject: Re: Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification   Fri Nov 25, 2011 5:32 pm

Report as replacement therapy in New York . http://astau.org.ua/vnimanie_konkurs_/otchet_o_kachestve_zamestitelnoj_terapii_v_nju-jorke/ Full report in English is available at this link:http://www.vocal-ny.org/wp-content/uploads/2011/10/Final-Methadone-Report1.pdf Tell all the truth is written? . It is interesting just to know it was true or not!
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PostSubject: The report Den suggested and wanted feedback   Mon Nov 28, 2011 2:13 pm

Den wrote:
Report as replacement therapy in New York . http://astau.org.ua/vnimanie_konkurs_/otchet_o_kachestve_zamestitelnoj_terapii_v_nju-jorke/ Full report in English is available at this link:http://www.vocal-ny.org/wp-content/uploads/2011/10/Final-Methadone-Report1.pdf Tell all the truth is written? . It is interesting just to know it was true or not!
I have not read this entire study and/or report but I have read quite a bit of it and it is very interesting and all OTP facility administrators should read it I am going to supply one to my clinic counselor as he and I have a lot of conversations on how to best suit the needs of clients etc....
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PostSubject: Re: Refresher on Federal Clinic Guidelines for Nonpayment of Fees And Administrative Detoxification   Wed Nov 30, 2011 7:38 pm

https://www.facebook.com/media/set/?set=a.199395476808966.48119.144910038924177&type=3 Look I think will Interestingly!
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