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Insurance and Heroin Recovery in Fresno County

Managing heroin recovery in Fresno County
Managing heroin recovery in Fresno County

People who think about going into heroin recovery in Fresno County worry about the barriers that will stand in their way to getting treatment. It takes a while for most people to get from the point of thinking about treatment to the time when they actually get into heroin recovery. In Fresno County, there are no more barriers than there are anywhere else. Most of the worries that people have are simply in their heads.

People wonder whether they can jump through the hoops put in place by their health insurance company. For the most part, the private insurance companies have successfully avoided paying for medication-assisted treatment for opiate addiction. The programs that offer methadone or buprenorphine often refuse to bill the insurance companies and they require payment up front.

However, because of the Affordable Care Act (Obamacare), more and more private insurance companies are reluctantly agreeing to pay for services. Ask the medication-assisted treatment (MAT) program that you are choosing if they will bill your provider. If not, you can submit the bills on your own.

Medi-Cal MCOs for Heroin Recovery in Fresno County

It’s possible if you qualify for Medi-Cal, it will pay for heroin recovery in Fresno County. California Medi-Cal uses managed care organizations (MCOs) that approve and process claims for the state. Each MCO has its own criteria for deciding what kind of services you can receive and they generally require you to have prior authorization for your treatment.

The case manager at the program you want to attend will need to submit a Treatment Authorization Request. It’s a simple process that the case managers perform routinely. They will need to notify the managed care organization that you have been diagnosed by a doctor and that your addiction has lasted longer than a year. The process ensures that your Medi-Cal MCO will pay for methadone or buprenorphine therapy for heroin recovery in Fresno County.

There is some talk that among the 21 managed care organizations that approve claims for substance abuse treatment in Fresno County or throughout California, one in particular resists paying for medication-assisted treatment. Obviously it cannot be singled out on this page, but you should be aware that state law requires that you have at least two options in choosing a managed care organization. If you belong to an MCO that refuses to pay for your heroin recovery in Fresno, you have the right to be switched to another one. Ask the case manager at the local methadone treatment program to tell you which MCOs they have good experience with.

There will then be a second stumbling block thrown in your way, but, again, the people at the medication-assisted treatment program will know how to overcome it. This is especially likely to happen if you opt for Suboxone or buprenorphine. The managed care organization may stop the pharmacy from filling your prescription until the doctor calls in their approval for you to continue the medication.

Making such phone calls is a routine job responsibility for the nurses at the medication-assisted treatment program that you attend. There is usually one nurse designated at a facility who will make those phone calls. Your role in the process is to take your prescription to the pharmacy early in the day, so that there is time to make the phone call if it becomes necessary.

Finding the Right Program

It’s easy to find a certified program that offers treatment for heroin recovery in Fresno County. You can access a list of county-contracted drug treatment providers through this link. If you do not live in Fresno County, you can visit the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment location tool at this link.

Whether you go through private insurance or if you qualify for Medi-Cal, your benefits will be processed through the Mental Health portion of the plan. Sometimes this is referred to as the behavioral health provider. Do not be offended by the label, because substance abuse treatment routinely falls under behavioral health services. You can talk to the assessment counselor at your local MAT program if you are worried about the stigma associated with seeking heroin recovery in Fresno County.

Ultimately, you are making the right decision to get help. Methadone and buprenorphine both offer a great potential for success if you seek out treatment for heroin recovery in Fresno County or anywhere. You can stop using heroin or pain pills without the withdrawal symptoms that you dread and the unbearable cravings that send so many people back into relapse, as long as you follow the rules of the program.

It is most definitely possible to regain health and happiness in your life if you get the right kind of treatment. Only you can make the decision to do that, but even if you go because of a court order you will still enjoy benefits from the help you’ll receive. Call your local MAT program now to find out how to get started, because there’s a life at stake: And it’s yours.

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