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)
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 Post subject: Insurance
PostPosted: Tue Aug 02, 2016 9:48 am 
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Joined: Fri Jul 17, 2015 11:47 pm
Posts: 2
I am SOOO disgusted and disappointed. I finally submitted all of last year's and this year's insurance claims to BCBSNC. I used all of the correct diagnosis and procedure codes-new ones starting after 10-1-15. I had already seen on my mobile app their denial of my claim. Just disappointed to have paperwork in my hand now.
Strangely, they are saying Procedure code H0020 is "non covered procedure code" but for this year I used the HZ etc (Sorry, don't want to lose place finding whole code) that was suggested. I in no way understand insurance and it gave me so much anxiety even filing it that I had the paperwork on my coffee table for SIX months putting it off!
I have a horrible time getting anyone at my insurance customer service that even gets what I'm talking about! Again-more anxiety!
How do you appeal? I have instructions on how to do it, and I know that Subs are covered. Why would they say I used old code or is that just "insurance speak" for methadone? Does anyone know if the fact that (it is my understanding) that insurance has to cover MAT a valid reason for appeal?
Does anyone here speak "Insurance"?
Off to work to make money for good old CMG!!!


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 Post subject: Re: Insurance
PostPosted: Wed Aug 03, 2016 7:04 am 
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Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
Well I would imagine that your insurance policy has to cover methadone treatment specifically, and just because they cover Subs, doesn't necessarily mean they cover MMT.

Have you checked the policy to see that they do cover MMT?

Your clinic should be able to give you the current insurance codes for MMT and claiming it back from your insurance, so you could check with the clinic that you're definitely using the right code, as they will just deny it if you are, without telling you the code you should be using, which is extremely unhelpful.

There is a FaceBook group, called Methadone Discussion, it's the largest one on FB, and I think you'd be able to get a lot of good information from that, as a lot of people there use insurance to pay for MMT, and I know there's some people that specifically use BCBS.

Here's the link, it's a closed group, so you'll need to click 'Join' and wait for one of the admin team to approve you, but that shouldn't take long;
https://www.facebook.com/groups/MethadoneTreatment/

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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!!


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 Post subject: Re: Insurance
PostPosted: Wed Aug 03, 2016 9:30 am 
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Joined: Fri Jul 17, 2015 11:47 pm
Posts: 2
Hey Sapphire! It's me, Denise Roushey!


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 Post subject: Re: Insurance
PostPosted: Fri Aug 05, 2016 6:44 am 
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Joined: Fri Apr 26, 2013 7:09 am
Posts: 186
Hi! Did you ask in any of the FB groups? I think you'd get a lot more answers that way.

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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!!


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 Post subject: Re: Insurance
PostPosted: Tue Sep 06, 2016 1:15 pm 
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Joined: Thu Sep 24, 2015 11:51 pm
Posts: 18
Location: KY
think i may go there to see about medicare and or medicaid.... im aggravated to no end myself... i have 3 ins and NONE want to pay a penny on my mmt nor reimburse me! Im fed up... and the "clinic" i attend dont know jack about diagnosis codes or procedure codes!!! I know more about them from being a medical assistant that any one in that whole place knows.... the dr dont know jack about it either! sorry im ranting all over the place..... im just aggravated as all get out... i live in ky and have to travel out of state to get my treatment which is costing me like $465 a month not to mention gas cost and 4-5 hours out of my day!


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 Post subject: Re: Insurance
PostPosted: Thu Sep 29, 2016 5:42 pm 
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Joined: Sun May 04, 2014 9:54 pm
Posts: 196
Location: North Georgia
Unfortunately Medicare still isn't covering MMT as a bundled service in OTPs. That's a big point of discussion between AATOD and CMS. Hopefully that will change soon... Medicaid depends on the state. It's a covered service in Georgia, but not all OTPs are able to take it.

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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


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