Is addiction treatment covered by insurance?

Posted at 11:45 PM, Apr 07, 2016
and last updated 2016-04-08 16:24:01-04

Melissa Babiarz knows how to help people battling opioid addiction. She's been doing it for more than 20 years, but recently, she's run into a problem. She's having to turn patients away.

"There may be a day where I have to turn away about three people," Babiarz says.

She says she's not able to be credentialed by the three main insurance carriers in Western New York. She is a New York State Licensed Mental Health Counselor and Credentialed Alcoholism and Substance Abuse Counselor. Her specialty is helping those who are battling opioid addiction.

She says her practice has tried, countless times to get credentialed to accept local insurance carriers in her office. She has been denied.

"They're saying they don't panel Licensed Mental Health Counselors and when you call them you get various reasons why," Babiarz said.

One major local health insurance carrier is Blue Cross Blue Shield of WNY. In a statement, BCBS said that the training required to be a Licensed Mental Health Counselor (LMHC) is less rigorous than the training for other specialists who treat addiction, like Licensed Clinical Social Workers (LCSW), physicians, and Registered Nurses. For example, according to BCBS, a Licensed Mental Health Counselor is required to complete 1,500 hours of hands-on training, whereas a Licensed Clinical Social Worker is required to complete 4,000 hands-on training hours.

As a result, BCBC does not reimburse Licensed Mental Health Counselors, like Babiarz, unless they work for a state-licensed clinic or group where they can be supervised and supported by others who have completed more extensive training.

Under that policy, according to BCBS of WNY, Babiarz will not be reimbursed by insurance while she is in private practice, but she would be able to offer insurance-reimbursed services if she chose to work in a state-licensed clinic or group.

Still, Babiarz is incredulous that she has to turn patients away because they can't afford to pay out of pocket, while other providers have waiting lists of people waiting to get help.

Now, she is looking to get together with other private practice addiction specialists here in Western New York who are also having to turn patients away.