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Opioid Awareness

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The role of health insurers in battling addiction

The historical view of health insurance companies is that they’re a barrier that keeps people from getting the care they need and are out for their own interest. Melanie Washington, behavioral health clinical coordinator at BlueCross BlueShield of WNY, said that historical view is certainly not the case now.

Instead, Washington sees BlueCross BlueShield as a leader in the community working to mitigate the local opioid addiction crisis.

One way in which health insurance providers can improve the opioid crisis is by promoting screening for those high at risk for opioid addiction. Washington said BlueCross has worked to increase coverage of primary care screenings for early identification of an addiction.

These screenings use predictive modeling to identify people who are at risk for an opioid addiction. For example, individuals with a history of mental health diagnosis or a previous substance abuse disorder may be more likely to develop an opioid addiction. Also, the longer an individual is taking an opioid prescription, the greater the chance they will become addicted.

Ann Griepp, medical director of behavioral health management at Univera Healthcare, said Univera covers screening for unhealthy alcohol and other drug uses. By answering four questions, patients start a dialogue about substance use that allows health care providers to understand patients’ views, goals and behaviors. From there, care providers can try and figure out a treatment goal, if the patient gives permission.

Similarly, BlueCross can offer its members support and guidance for battling opioid addiction, either by directing them toward the proper resources or providing educational information and material.

Washington said federal and statewide laws restrict the level of assistance insurance companies can provide, however.

“It is challenging that in many ways our hands are tied in terms of our ability to communicate with others what is going on,” she said.

Health insurance companies need signed, written consent to disclose any substance abuse-related information to others in the health care field.

That’s why Washington said members can work with their insurance providers to improve the local opioid crisis by signing the consent releases. It increases the flow of information and communication among health care professionals.

For example, Washington said she knew of a father whose son had gone to the emergency room five times due to opioid overdoses. The opioid overdoses were not communicated to the young man’s family or his primary care doctor. The family was notified by the ER when the son passed away due to an overdose. If the ER had consent to release substance-abuse related information, the family and primary care doctor would have been aware of the repeated emergency room visits.

Both BlueCross and Univera have behavioral health teams that can help people find the necessary substance abuse recovery resources, education and information about what their insurance covers.

Washington said medication-assisted treatment, such as methadone and suboxone, is partially covered by some BlueCross plans. It is certainly covered for those who have coverage for prescription medication.

“We don’t have any limitations to accessing any of the medication-assisted treatments that exist,” she said.

Griepp said Univera covers medication-assisted treatment, inpatient and outpatient care and detox programs.

Because individual plans vary, members are encouraged to call the behavioral health team to see what their insurance policies cover.

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