HOW DO I GET BCBS TO PAY FOR METHADONE GIVEN AT A TREATMENT CENTER??

Please  help me as soon as u can if u have an answer for me.  Iv'e submitted my claim to bcbs . They have all the numbers and everything they need but they cannot file the claim with the code H0020, they need an alternate code.  They say this code cannot be submiited for the claim. They say it's a valid code, but they need a different one to submit the claim.  HELP

Heather

Hey does any1 know anywhere in south jersey i can call to help get funding for methadone. I been on heroin for 9 years, newly clean for 4 months now.....but im self paid and i cant afford it anymore with a child and just losing my job. I need help, i dont want to go back to the streets, im scared and im losing hope all over again.

I know in PA if you lose it all you can go on Gateway or Welfare insurance and they'll cover costs and travel..only problem is if you don't have to pay will you ever leave the program? I know I wouldn't if I didn't pay...

If you are looking to gain a return from your clinic cost, you are going about it all wrong. When you file your taxes is when to do it. Example, In Alabama, the state i live in allows you to write off anything over 7.5% of you gross yearly wages can be gained in tax returns.. heres a crude formula (gross income / 7.5% = X) Amount spent on medical - X = What you will get in return.. Hope this helps ya!!

Kelly1986 - I see this post is a year old, I am looking for help with codes as you described above and I have a benefits advocate who also wants to help with reimbursement of some sort. May I send a private communication somehow?

Thanks!

An MD MUST prescribe the methadone & monitor EVERY patient in EVERY outpatient methadone program. ALL increases & decreases in the dosage are written by the MD, as well. Just b/c the patient does not see the doctor every single day the medication is taken doesn't have anything to do with this. A pain patient on the outside, receiving methadone for pain doesn't take the medication in front of his MD every single day, either. So this is flimsy & inaccurate reasoning when it comes to why MMT patients wouldn't be covered by major insurance carriers. I'm not trying to call you a liar or sound like I'm being argumentative - only trying to point out that literally there's NO difference in the prescribing of the medication, & if ANYTHING, methadone maintenance patients are monitored MORE closely for side-effects, either by doc(s) AND/OR dosing nurses every single time they enter the clinic to dose! Take-homes may be the exception, but the pain patient takes home a MONTH of medication after getting a script. So this makes no sense to deny it on this premise. I highly doubt this that is the reason. Discrimination b/c addicts are seen as morally bankrupt people who made a bad choice to get to where they are is a MUCH likelier reason. I'm an MMT patient myself, & BCBS of Illinois (through Walmart, my former employer) paid for 4 months of treatment for me after a year of coverage with them, then turned right around & called me to demand all their money back b/c they claimed they did an audit & had incorrectly covered the treatment. I'd told them the day I bought coverage on the phone that if they wouldn't cover it in a year, I couldn't afford to buy coverage. They ASSURED me they'd cover it. Then they pulled this stunt. So I told them when they sent me back ALL of my premiums, I'd pay them ALL their money back. I never heard from them again, after 1 more email asking for their money. I also never paid another premium to them!

Not sure if you are still looking for information, being your post is over a year ago. My son goes to a methadone clinic on a daily basis, having to pay up front. However, I have been aggressively working with BCBSMN monthly for him to be reimbursed. It isn't always 100% due to copays, etc., but something is better than nothing!

can you help me also??? I just read your post about methodone. My husband has been on it for over 20 yrs. and working 2 jobs, owns a house and is doing great. He was recieving a 20 dollars slot but now since the president started this new healthcare system he no longer has the slot and has to pay 100 weekly. He has Bluecross here in rhode island but they won't pay for it...After doing great for over 20 yrs. he now might have to be forced to detox which is a dangerous thing being on over 130mls. daily...If you know anything i don't about getting this payed for or even cheaper than 100 weekly, please please help him keep his life in order...The insurance is great but he might be forced to get some cheap neighboehood plan thats nowhere as good as bluecross...

 Hello,  I go to a methadone clinic in Alabama. I am signing up for bcbs of alabama and want to know if any of the plans will pay ( or help pay ) for it. I get my takehomes and only go once a week. 84 a week is killing me and I know a clinic in Huntsville that takes medicaid, so I was wondering if anyone knows if this is possible. Thanks for your time.

All do my respect you are very wrong because you just see one side.My Wife goes to methadone clinic and its financial burden.You said They are not generally assessed by a licensed clinician.It is not posibble liquid methadone is very restricted usage by state and federal govermant if they dont see by license phisician they cant get methadone.But then again thats how insurance companys make big money

I actually work at a Methadone clinic and submits the claims for our patients. I submit a claim one time a month. Mainly because we are not a provider of BCBS but file claims as a curteous for our patients. However, many claims get denied and it is very time consuming to file. Lately, most of our claims are being paid but only a portion of it. My advise to you is, ask BCBS for a 1500 claim form, complete it yourself (not being sarcastic about it). It is really not too difficult. Just ask the clinic for a print out of your payments for the past however months you need to file and go from there. You will also need the clinics CPT code and Dx code. And if possible ask them for a sample copy of a claim as a guide you can use.

I would love some info also if your. Able I'm kind of in the same boat right now and need a little help

Anyway to force these clinics to go I NETWORK and sign up as preferred providerrs? 

I signed up with Humana under the AFFORDABLE HEALTH CARE ACT.

There was two INSA companies in my state that got in the marketplace. Humana and Blue Cross.

 

What doesnt make sense is that IF "OBAMACARE" says that they are required to pay 100% of SUBSTANCE ABUSE TREATMENT AFTER your copay is met then that should be the law.

 

Instead these clinics do not want to go IN NETWORK because the re-imbursement rate is far from the $14 a day they charge. If one goes OUT of NETWORK then under my plan,, I have to pay $9520 before my insyrance pays a dime. Doesnt matter that I have met my yearly deductable. There isn't a methadone clinic in my state that is IN NETWORK for Blue Cross or HUmana.

 

It looks like when these two insurance companies were bidding for MARKETPLACE clients, they should have known that they would have to pay for OUT OF NETWORK providers.

 

It only cost a little over $5200 for me tio pay OUT OF MY POCKET  per year. I would never get to $9,520. Sort of defeats the purpose of the affordable health care act.

 

I am left with filing a complaint with the insurance commisioner of my state or Heath and Human Services  ( OBAMA CARE )  becauee these clinics arfen't going to budge.

 

Maybe the Obama Administartion can put pressure on these clinics through the DEA since they pull thier strings and the clinics are at6 their mercy.

 

I am at my ropes end.

 

SUGGESTIONS ANYONE??

 

I am in alabama.

 

Kelly, thank you for the information. It was very generous for you to take the time and give the facts re: Methadone and insurance benefits. I am on a Methadone maintenance program and being given the criteria that has to be met is very valuable. I did not have someone to explain the system to me so there was a lot of trial and error.

JollyGemini, I understand the judgement and controversy re: Methadone treatment. It leaves us very guarded and sometimes defensive, but, I found Kelly's response as factual and not at all personal. Please reread her response and use the information to your benefit. It's not often we get free inside information.

Help!!!! Hey, I have a question since you work at a clinic. My clinic doesn't take insurance- cash only. Im trying to file my claims & I have my diagnosis code (304.01) but I need a procedure code. Since my clinic doesn't file insurance they don't know what the procedure cold would be. Thanks for any help!!