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

Hi, All! I goto a clinic in Kentucky. I live in Ohio and have Anthem BCBS through my employer (a local school system I've worked for nearly 20 years now). I've gone to this clinic for approximately 8 months and have had GREAT SUCCESS with the program (after abusing opiates for more than 15 years... starting post-surgically, and did a detox in Kentucky 7 years ago that was an utter failure... BTW... BCBS paid almost ALL of the cost for the 7 day inpatient detox)(also, I haven't touched an opiate of any kind for 7.5 months...). The clinic I attend now is $15/day or around $430/month. I've lost a vehicle that, ironically enough, had a payment of $431/month. Glad to sacrifice the car to be off the opiates. I provided all of my heath insurance to the clinic when I started in August 2016. In January, after hearing nothing about insurance reimbursement, I asked the man who takes care of billing what the status of my claim was. He hadn't even filed with my insurance. In fact, he made 2 copies of my insurance card in 5 days because, presumably, he lost the first one. He asked me how long I had insurance with BCBS... I replied, "14 years". He then asked, "so you had BCBS since January of 2016?"... (Uhhhhhh..... this guy is over billing?!?!?!). He told me around a month ago that he hadn't heard anything from my insurance yet. He also said that I would have to meet my deductible first even if BCBS covers the clinic. I met my deductible around 5 weeks into the calendar year ($500). What should I do now? Should I stay on this man or should I personally contact BCBS to demand they cover the clinic? I have decided that if they do not cover it, I will drop my health insurance and use the $200ish premium I pay a month to pay part of my monthly visits to the clinic. I do not have a family physician and, luckily, have no current health issues that need to be addressed by a doctor. My present income qualifies me for charity care at the local hospital ER's, so if I get sick enough, I have that to fall back on. Any help or advice would be GREATLY appreciated.

Methadone treatment in nj is NOT 100 percent free. It is NO percent free!

I have no insurance and want to get on methadone to get of heroin please help me to be able to get methadone asap because im wanting to die

Omg i am having the exact same problem i was denied same percedure code HO020 please help they said this is the code but then i get denied now i got a new code hopefully it works (99408) i hope so i don't have the money to keep paying every week .

Thank you sooo much for saying this. Also I would add a counselor is there anytime the clinic is opened and at least once a month you HAVE to see your counselor or don't get dosed. Unless theres an understanding between you and the counselor. I now live in South Carolina and medicaid doesn't cover methadone but Connecticut did! I pay $13 a day or $312a month. Its alot for just getting SSI once a month. Do you know how or who I could write to to accept insurance and medicaid for methadone maintenance? I know SC covers suboxone and basically does the same thing and its newer, so wouldn't it be cheaper to cover methadone then suboxone? I tried suboxone but didn't work for me but methadone daily does, routine, maybe i don't know but it does and would like South Carolina to accept medicaid or sliding fee scale for workers.

If you don't mind I would also like to get the revenue codes

Almost every day in the news these days its the same story, " opiate addiction in this country has been at epidemic levels for so long now. Someone dies from an overdose now every 7 min"
Then you read these post . Scratch your head and realize its just talk. Cost , insurance and ignorance keeps treatment just out of reach for so many suffering.

I have been an opiate addict for over 20 years starting from a injury or accident then being medicated by my Dr. as a result. In 7 years I successfully completed over 10 inpatient treatment centers. I can recite the steps from memory. However I find that my will power to stop my opiate use, works about as good as my will power to stop a bad case of diarrhea. I spent 15 of those years hating myself more than all those people close me. I prayed for death everyday but was too much of a wuss to pull the trigger. I was "normal " in all respects except when it came to my ability to stop . People would say "you have so much to live for, why don't you just stop". That still sounds so crazy.

I say all this because I have found that methadone is the only thing that has allowed me to live a somewhat normal productive life. For me its not just the methadone medicine its self. Its the whole program. Having a counselor that I can see daily. Someone I try to stay accountable too. Its the random drug test. The nurses the Dr. and all the support staff that my clinic offers. Now believe me I have to want to be clean more than I want anything else. Methadone has without a doubt saved my life. However it is not perfect solution. It comes with some terrible side effects but compared to the alternative I am very grateful for it.

With all of the millions of people just like me. Or shall I say the old me suffering in active addiction. Yes chronic addiction brings with it a hopeless state of mind and body that I'm afraid very few will with out the affliction will ever understand. Why is treatment so out of reach and hard to come by. I have to pay $210.00 per week. I drive an hour and a half each way. I'm sorry what I mean to say is. I am one of the few lucky ones. I get to drive an hour and a half each day, I thank God most days. When I really think about it tears come to my eyes. I say "why me, why am I so lucky. I have found this miracle. I feel guilt because for every person like me fifty addicts suffer and will end up dead or locked up. Sometimes I compare my gift with someone that won the lotto. Why was I given a second chance and not them.

I have great insurance but I guess someone decided that.
EVERYONE JUST SHOWS UP AND GETS THEIR MEDS. This is after the initial history, physical and counsel phase. I don't know where you are, but in All the clinics I have reviewed, that IS the case. The only exceptions is if the patient is intoxicated by something, or on hold by their counsel person. I don't know why the truth insults you. This reply is to "guest".

It is 2017. I don't understand why some weeks I have to decide to dose (treatment) or eat. Sometimes I cant afford both. It is unreal that treatment is so UN accessible. For a illness to be classified a disease it has to be incurable, progressive and fatal. Addiction has been classified a disease by the medical community for over 50 years. However when someone has cancer all is sorry for him while the addict remains a piece of sh*t by the majority.

History has taught us that the majority does not always have the right answers. A little more than 100 years ago my fellow southerners or the majority felt it was OK to own slaves. Treating them as tools such as mules. A little more than fifty years ago blacks could not eat in a white restaurant. They could not drink from the same water fountain as whites or sit at the front of the bus.

For real change to happen. Someone has to say enough. .Like Rosa Parks and have the courage to say "I will not go quietly into the night" She did not have to burn the bus to change the world. She just had to have the courage to make a stand. For all of us that know what its like to be part of the throw away generation. How many more sons, fathers or daughters have to die before our Rosa Parks comes along.

Love a little more.

“People deny reality. They fight against real feelings caused by real circumstances. They build mental worlds of should s, ought s and might have-been. Real changes begin with real appraisal and acceptance of what is. Then realistic action is possible”
David Reynolds

I desperately need help with this as well. we have an upper level blue cross blue shield plan through my husband's company and i have had 2 attempts at seeking coverage fail, though we know others in treatment in the same clinic with bc/bs coverage. Plus, there is another clinic out of our area ( too far away) that files claims for their patients and it is covered. Sealing any help you can give! Your time and interest is greatly appreciated!
Wendy Parker

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I read your post and I've been in same clinic for 17 years and I I not show up just to get medicine which that's what I call it, I look forward to going because I really need to talk to someone I can trust so would you mind sending me the insurance info..my clinic takes medicade but I receive Medicare and medicade is secondary so I have to pay and I have paid a lot in 1 years..here is my email if you would send me the insurance info..on in virginia.....thanks Liz

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Hello iam bobby I too have bc bs nc I have had it a yr and been going to the clinic downtown Fayetteville nc they have told me there out of network so they won't reimburse me I have some new codes from administrator at clinic I go to iam doing very well there but financially it's hard I pay so much for insurance and I can't use it for this doesn't make sense maybe I could get some help how to get reimbursed also I would definitely appreciate your feedback or any time you have spent assisting us and thanks on behalf of all us

You are mistaken in your assumptions regarding pharmacotherapy treatment/methadone maintenance in a clinic setting - methadone, even in a clinic setting, is administered as a PRESCRIBED MEDICATION - patients MUST be assessed by a licensed doctor BEFORE and DURING treatment. In fact, every 6 months they are required to meet with the prescribing doctor to discuss their doseage in the form of a "med check". They are also required to have a full physical annually with the doctor. The methadone is administered to the patient by a licensed nurse, unless they have earned "take homes" through extended "clean time" (clean urine drug screens for a predetermined period of time - for example, after 3 months of negative drug screens the patient can have one take home dose...after 6 months they earn a second one, and so on - though the rules regarding take homes vary clinic to clinic and state to state). Printed on the take-home bottle label, along with the patient's name and prescribed doseage, are the words "Prescribed by..." followed by the doctor's name. They don't just hand it out, it is a prescribed medication.

Patients are also required to complete a specified number of hours of therapy every month, both in the form of group therapy and individual, one-on-one, therapy with a counselor or therapist. This part you have correct - many of the "therapists" are actually counselors with very little, if any, experience in working with recovering addicts. Some haven't even any prior experience as a THERAPIST, let alone a drug & alcohol therapist, and have only just completed a several week to several month long course giving them certification to do so. However, many clinics do, in fact, have licensed psychologists and/or psychiatrists on staff as well as licesnsed therapists.

I am trying to get the code too I knoe diagnosis code 304.00 is for any opioid meds but it says H0200 is that code you need to file with BCBS but I hear there is another code

The code you have posted.... after speaking to my old counselor forever ago stated that he had also had a patients bcbs pay for his but I have wondered which it makes complete sense if there is a doctor “exam/eval” code and an additional code for the medication bc if u think on it we all go to the doctor for an eval if sick they file a code then we go to the pharmacy for our medications which they then file a code for payment also so it makes sense that there are multiple codes atleast two that need submitted which could be most of the problems people are having. Do you know if you for sure have onebcode u file or two? If only one do you know the description of that code like what the code states?

I go to a clinic in Wichita Kansas and I had to print the claim page off of the BCBS website and then submit the REQUIRED information (it tells you at the bottom of the 2nd page what you need-one piece you most likely are missing is the tax ID number of the MMT clinic) also must submit with diagnosis and prognosis codes. you can email or mail the claims for processing. hope that helps!!!

I have been on methadone treatment since 2007. Husband has anthem and highest tier. When the representatives came to sign him up for new year. They specifically said they would be covering methadone maintenance treatment as of that new policy took effect. Have had nothing but trouble trying file claims. And no help from anyone from anthem. I was covered for about 3 years. That's 15 dollars per day at 108 per week 432 month x that by 36. That's a lot money. Even if was reimbursed at 40%. Said was they pay 60%, we pay 40%. They don't file insurance there so have mail and submit claims yourself. Have talked other people whom had problems but was reimbursed eventually. I need help on where to go. I haven't been covered for about 2 years now. But steadily tried submitting claims different ways per anthem.