Navigating the ins and outs of insurance can be a difficult and confusing process, and, for many people, it adds yet another hurdle to seeking proper care for opioid use disorder (OUD). No one should feel discouraged from getting the help they need, so we’ve put together this guide to help clarify the nitty-gritty details of insurance coverage. Below, members of Fidelis Care in New York can find the information they need concerning their plan’s coverage of Suboxone® for OUD treatment.
What you need to know about Fidelis Care’s Suboxone coverage in New York
Coverage details
Fidelis Care offers Suboxone coverage in New York on all available health plans. You do not need prior authorization from your insurance plan before receiving Suboxone, meaning doctors can get their patients on the path to recovery quickly and efficiently, without having to wait for the insurance plan’s approval. Fidelis Care plans with Suboxone coverage in New York include Child Health Plus, Essential Plans, Healthier Life (HARP), Medicaid Managed Care, Medicare Part D, and Qualified Health Plans.
Telehealth availability
Access to telehealth support for opioid use disorder treatment depends on what insurance plans the telehealth provider accepts. At Ophelia, we offer comprehensive telehealth services for Suboxone treatment, from enrollment to ongoing care and support.
To provide service to as many individuals in need as possible, Ophelia accepts a wide range of insurance coverage options, including:
- Medicaid Managed Care
- Health and Recovery Plan
- Child Health Plus
- Essential Plan Aliessa & Essential Plan QHP
- Medicare Advantage
- Managed Long Term Care-Medicaid Advantage Plus
- Health Benefit Exchange
You can find Fidelis Care’s OUD treatment coverage chart here.
Additional benefits
Treating opioid use disorder is most effective when patients also receive behavioral support and psychotherapy. Many Suboxone treatment providers, including Ophelia, offer referrals to aid all patients in finding the full spectrum of help they need. These additional treatment methods may also be covered by insurance, so check with your Suboxone treatment provider.
Can NY Medicaid members get Suboxone treatment?
Whether Medicaid covers Suboxone treatment is the question many people seeking OUD treatment ask. Thankfully, Medicaid offered through Fidelis Care covers medications for addiction treatment. You can find more useful information on Fidelis Care’s Medicaid FAQ page and NYrx, the state’s Medicaid pharmacy program.
Is naloxone covered?
Naloxone, sold under the brand name Narcan, is a life-saving opioid antagonist that can reverse the effects of an opioid overdose and help a patient stabilize quickly. Fidelis Care’s Medicaid program covers naloxone in injection and nasal spray forms.
How telehealth works
Telehealth is simple: Patients can receive medical guidance and care over the phone or through a video call using a platform, like Zoom®. Doctors and their patients can discuss medical concerns and needs, reach a diagnosis, and prescribe medication all remotely. This all makes it a convenient option for people with unreliable access to transportation, those who can’t leave the house, and those in rural areas who can’t make frequent trips to a faraway clinic.
Most healthcare plans, including Medicaid, now cover telehealth appointments. Telehealth has been particularly influential in helping OUD treatment become more accessible to those who need it. It has increased patients’ privacy and allowed them to maintain normal schedules by reducing disruptions to their work and social lives.
Ophelia’s process
At Ophelia, we want to make OUD treatment as easy, accessible, and successful as possible. Our treatment process begins when patients meet with an Enrollment Coordinator over the phone or on Zoom. Enrollment Coordinators are there to answer questions about the process, and they can even work with patients to figure out the complexities of insurance and coverage availability.
From there, patients have an initial visit with a clinician to establish care and design an individually tailored treatment plan. Once a new patient begins their Suboxone treatment, their clinician will set up a series of follow-up calls and video visits to ensure the process goes smoothly. Each session takes place on Zoom, and additional help is available through phone, text, or email as needed.
Our clinicians focus on getting patients stable and designing a long-term course of action. This includes our non-punitive remote urinalysis testing. We provide the test kit and walk you through the process of testing at home and displaying your results. The goal is to establish a baseline and monitor progress, never to punish anyone for a positive result. We don’t kick people out of treatment; instead, we help them get back on track.
Every patient comes to Ophelia with unique needs, so we offer a range of additional support services at no extra cost, including peer coaching, diagnosis of related mental health conditions, and ongoing therapy.
If you’re a Fidelis Care member and need help with opioid use disorder, we’re here to provide support and resources. Find out if you’re a candidate for Ophelia by scheduling a brief exploratory call.
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