We Speak Methadone (and buprenorphine)

A NAMA Recovery Forum for Medication Assisted Treatment patients, family and advocates. (Issues or Questions about registration and/or the forum? Email zac@tnmethadone.org OR sapphirematthews@gmail.com)
It is currently Fri Nov 24, 2017 8:12 am

All times are UTC - 5 hours


Forum rules


Please click here to view the forum rules



Post new topic Reply to topic  [ 10 posts ] 
Author Message
 Post subject: Insurance Companies Still Putting Up Barriers To Treatment
PostPosted: Sat Oct 10, 2015 8:29 am 
Offline
Administrator

Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
Interesting article about insurance not being accepted even in this supposed age of Parity.

http://atforum.com/2015/10/age-parity-p ... bursement/

Medicare, Medicaid, and commercial insurance—all three programs are putting up barriers to reimbursement for treatment in an opioid treatment program (OTP), but the situation is getting better, at least in states that expanded Medicaid.

Parity doesn’t apply to Medicare, so that presents a huge problem for patients who are covered by Medicare because of age or disability.

_________________
Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Sat Oct 10, 2015 1:02 pm 
Offline
Administrator
User avatar

Joined: Sun May 04, 2014 9:54 pm
Posts: 196
Location: North Georgia
This was a good one, and it highlights a REAL problem. Medicare and Medicaid aren't subject to parity (unless Medicaid is through a managed care organization).... but Medicare does not cover Methadone Maintenance Treatment as a bundled service in an Opioid Treatment Program, and that's a BIG problem/issue. Thanks for sharing this.

_________________
Zac Talbott, CMA
Email | zac@tnmethadone.org

Chief Operating Officer | Counseling Solutions Treatment Centers
Comprehensive Opioid Treatment Programs
Program Director | Counseling Solutions Treatment Centers - Chatsworth


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Fri Oct 16, 2015 5:38 am 
Offline
Administrator

Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
I'm not surprised that people are confused about what they should be doing post ACA, as it's all very detailed and not at all simple!

Hopefully as time goes on, and it's rolled out everywhere, it will get less complicated.

I think it's very unfair that these companies will pay for abstinence based treatments, and even Suboxone in some cases, but not for MMT. :(

_________________
Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Fri Oct 16, 2015 1:53 pm 
Offline
Administrator
User avatar

Joined: Sun May 04, 2014 9:54 pm
Posts: 196
Location: North Georgia
We have new coding for insurance and diagnoses, procedures, etc. that rolled out on 10/1 of this year.... There are now much more specific codes, and I think that will help. For example, there is now a ICD-10 procedure code specific to "Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance" where as before, in ICD-9, there was no procedure code specific to MMT as a bundled service. The only procedure code we had before was not an ICD code, so Medicare and many other insurances didn't recognize it...it was hit or miss. I think that will help as well. There is ALSO a more specific diagnosis code now too... the ICD-10 diagnosis code is now specific not only to opioid use disorder but also signifies "in remission on maintenance therapy." So hopefully the new coding will help. Even if folks can't get coverage back to Jan. 1st of this year, hopefully starting 10/1 it will be a different (much better) story.

I'll list all the codes here... ICD-9 codes are the "old codes" that are used through 9/30/2015 (so if you're submitting for re-imbursement or coverage back before 10/1/15 you'll still need to use these "old codes)." The ICD-10 codes are the "new codes" that need to be used starting 10/1/15 going forward.

ICD-9 (through 9/30/15) Codes:
Diagnosis Code: 304.00 Opioid Type Dependence, unspecified
(Source: http://www.icd9data.com/2014/Volume1/290-319/300-316/304/default.htm#304.0)
Procedure Code: H0020 Alcohol And/Or Drug Services; Methadone Administration And/Or Service (Provision Of The Drug By A Licensed Program)
**NOTE: This procedure code is NOT an ICD-9 code (there is no ICD-9 code specific to MMT), so it is not universally recognized. It is NOT recognized by Medicare, though it is by different private insurance companies. (Source: https://www.hipaaspace.com/Medical_Billing/Coding/Healthcare.Common.Procedure.Coding.System/H0020)

ICD-10 (from 10/1/2015 going forward) Codes:
Diagnosis Code: F11.22 Opioid Dependence, uncomplicated, on maintenance treatment
(Source: http://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F11-/#F11.22)
Procedure Code: HZ91ZZZ Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance
**NOTE: This is the first ICD procedure code, with the new codes through ICD-10, specific to MMT. Even if you don't have luck going back to Jan. 1st using the older codes above, many patients should start seeing coverage with these new ICD-10 codes now that they will be universally recognized. (Source: http://www.icd10data.com/ICD10PCS/Codes/H/Z/9/1/HZ91ZZZ)

Phew! After putting all that together perhaps we should have this info in a separate post up top under announcements or something?

I hope this helps some folks!

_________________
Zac Talbott, CMA
Email | zac@tnmethadone.org

Chief Operating Officer | Counseling Solutions Treatment Centers
Comprehensive Opioid Treatment Programs
Program Director | Counseling Solutions Treatment Centers - Chatsworth


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Sat Oct 17, 2015 6:58 am 
Offline
Administrator

Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
Thanks for listing all the codes Zac, people are often looking for them, so at least I know where to send them now!!

_________________
Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Fri Feb 05, 2016 1:44 am 
Offline

Joined: Thu Sep 24, 2015 11:51 pm
Posts: 18
Location: KY
in yall's opinion.... would it be better to try to get reimbursement or try to get payment of services to be obtained? I have tried both and i havent gotten anywhere..... im just so very frustrated with the DENIED answer i get after months of "call back in a couple weeks" or "we didnt get the forms that were sent" and so on and so forth with the excuses..... im totally fed up with the insurances i have! i have Gateway aka medicare assured, Medicare and medicaid wellcare of ky....... idk what to do.... i been in treatment 8 years and i have handed that place soooo much money its not even funny! the cost is only going to keep going up and i really cant afford it now.... im detoxing but at 2 mg every other week and i still have over 100 mg to go..... what should i do... i already travel to another state to get my treatment because ky laws say that a person can get a week take home only 2-3 days at a time... i get a 2 week take home where im at now. but im so scared im going to get a false positive which happens there ALL THE TIME to ppl.... even to someone close to me that attends the same place and this person has also been going 8 years and this person lost the one month phase until the GCMS come back showing a false positive but it was the 11 days of this person having to go there and back 11 days in a row... i took this person the 122 mile round trip over there and back home as this person works 3rd shift! so anyways.... yall got any suggestions? my family dr tried to use an F19.19 code and idk if that is even right.... what to do yall....????


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Fri Feb 05, 2016 7:58 am 
Offline
Administrator

Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
I'm not sure squbbles, I think that Zac would be the best person to answer this one!

_________________
Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Fri Feb 05, 2016 4:39 pm 
Offline

Joined: Thu Sep 24, 2015 11:51 pm
Posts: 18
Location: KY
Thank you sapphire! I'm gonna see if I can get a friend req to him! I met him in person once! He came and spoke to the clinic I attended! He's a nice guy! Seems to be very knowledgeable! :) thank you so much :)


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Sat Feb 06, 2016 7:53 am 
Offline
Administrator

Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
Squbles, Zac's 'tndirector' on here, so you can either PM him from the board, or just post a post addressed to him, and he'll pick it up

_________________
Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


Top
 Profile  
 
 Post subject: Re: Insurance Companies Still Putting Up Barriers To Treatme
PostPosted: Sun Feb 07, 2016 4:47 am 
Offline

Joined: Thu Sep 24, 2015 11:51 pm
Posts: 18
Location: KY
tndirector wrote:
We have new coding for insurance and diagnoses, procedures, etc. that rolled out on 10/1 of this year.... There are now much more specific codes, and I think that will help. For example, there is now a ICD-10 procedure code specific to "Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance" where as before, in ICD-9, there was no procedure code specific to MMT as a bundled service. The only procedure code we had before was not an ICD code, so Medicare and many other insurances didn't recognize it...it was hit or miss. I think that will help as well. There is ALSO a more specific diagnosis code now too... the ICD-10 diagnosis code is now specific not only to opioid use disorder but also signifies "in remission on maintenance therapy." So hopefully the new coding will help. Even if folks can't get coverage back to Jan. 1st of this year, hopefully starting 10/1 it will be a different (much better) story.

I'll list all the codes here... ICD-9 codes are the "old codes" that are used through 9/30/2015 (so if you're submitting for re-imbursement or coverage back before 10/1/15 you'll still need to use these "old codes)." The ICD-10 codes are the "new codes" that need to be used starting 10/1/15 going forward.

ICD-9 (through 9/30/15) Codes:
Diagnosis Code: 304.00 Opioid Type Dependence, unspecified
(Source: http://www.icd9data.com/2014/Volume1/290-319/300-316/304/default.htm#304.0)
Procedure Code: H0020 Alcohol And/Or Drug Services; Methadone Administration And/Or Service (Provision Of The Drug By A Licensed Program)
**NOTE: This procedure code is NOT an ICD-9 code (there is no ICD-9 code specific to MMT), so it is not universally recognized. It is NOT recognized by Medicare, though it is by different private insurance companies. (Source: https://www.hipaaspace.com/Medical_Billing/Coding/Healthcare.Common.Procedure.Coding.System/H0020)

ICD-10 (from 10/1/2015 going forward) Codes:
Diagnosis Code: F11.22 Opioid Dependence, uncomplicated, on maintenance treatment
(Source: http://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F11-/#F11.22)
Procedure Code: HZ91ZZZ Pharmacotherapy for Substance Abuse Treatment, Methadone Maintenance
**NOTE: This is the first ICD procedure code, with the new codes through ICD-10, specific to MMT. Even if you don't have luck going back to Jan. 1st using the older codes above, many patients should start seeing coverage with these new ICD-10 codes now that they will be universally recognized. (Source: http://www.icd10data.com/ICD10PCS/Codes/H/Z/9/1/HZ91ZZZ)

Phew! After putting all that together perhaps we should have this info in a separate post up top under announcements or something?

I hope this helps some folks!



Hi Mr Zac! Can u plz look at my post up above about me getting denied by my insurance Plz.... I'm a bit on the frustrated side with my ins.... Thank you so much


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 10 posts ] 

All times are UTC - 5 hours


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
cron
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group