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Methadone on Private Insurance for the Employed

Comments (2)
answered 06:02 PM EST, Sun January 19, 2014
tes72 tes72 somerset
Iam on 12 mili methadone daily. My hausband and I work instead of living off the state. it costs us 800$ a month between fuel and med. I see all these people on Medicaid get free med and fuel pay back; this is not fair. It is like the state does not want you to work. We have great health insurance; however I can not find a doctor or clinic that takes private insurance for this service. I fell this is very unfair; we are having to let bis get behind to pay clinic; while others take over 100 mili a day and the state pays them! Can someone please help me find a service that takes private insurance? I live between Johnstown and Greensburg Pa. Thanks.

Anna Deeds Says...

Thank you for your question. This question is a repeat of one already answered. Here is my answer:

I am unaware of any methadone clinics in your area that take private insurance. I agree that this is not fair. It puts people who work at a disadvantage. It almost encourages people on methadone to not work because most of your salary ends up paying for your medication. 

However, there are a couple options you can try. First, call your insurance company. There should be a number on the back of your insurance card. Ask your insurance company if they cover methadone for addiction. Methadone can be used for addiction or pain management. You need to know if they cover it for addiction if you go to a methadone clinic. If you get methadone from a doctor for pain, then you need to know if they cover it for pain. I'm assuming that you go to a clinic. If you go to a methadone clinic and your insurance does cover methadone for addiction, ask them if there are any other methadone clinics in your area that take your insurance. If there aren't, ask how you can be reimbursed for your costs.

Some private insurances do cover methadone. Your methadone clinic may not take the insurance but if your insurance covers methadone you can be reimbursed for some or all of your costs. For a provider to take any insurance, they have to go through a complicated credentialing process. Many of the methadone clinics aren't credentialed but this doesn't mean your insurance doesn't pay for methadone, only that the clinic doesn't take your insurance. So, you would have to send your receipts and fill out some forms to get your insurance to reimburse you for what you pay to the clinic. It is possible that they cover all of your costs or a percentage. For example, they may pay 80% and you pay 20%. Even if they only pay a percentage, this would save you a lot of money.

Second, consider switching to Suboxone. If your insurance doesn't cover methadone, it may cover Suboxone. If you need to do this, be sure the Suboxone doctor is aware you were on methadone. They may need to give you Subutex for the first few days or they may ask you to wait three to five days after your last dose of methadone to begin the Suboxone. Suboxone has a blocker in it that will cause withdrawal symptoms if you take it while there is methadone in your system.

Just to review, here is what yo need to do:

  • Call your insurance company
  • Ask your insurance company if they cover methadone for addiction
  • Ask if there are any clinics who take your insurance
  • Ask if they can reimburse you
  • Ask if they cover Suboxone
I hope this answers your question and good luck with your treatment.
Since this question was a repeat of one already answered, you can find the complete question and answer at this link - http://www.choosehelp.com/experts/drug-treatment/drug-treatment-anna-deeds/methadone-on-private-insurance.  
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Page last updated Jan 19, 2014

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