Manifest Money Talks

My question involves insurance law for the state of: TN



I was being prescribed hydrocodone before I became pregnant. Unfortunately, I became dependent on it. When I found out about the pregnancy, I told my obstetrician about it because I wanted to do what was best for my baby. Suprisingly, his response was that opiate withdrawl is more dangerous for a fetus than a constant, maintained dosage. Since I was dependent, he said I couldn't rely on my own willpower to maintain a consistent dosage. Instead of hydrocodone, he decided to put me on a Methadone Maintenance program. I had heard how Methadone detox was the most wretched and long-lasting drug withdrawl known to exist. This is due to its long half-life. I begged not to be put on it, but I couldn't be selfish and had to do what was best for my little one.

The cost was $360.00 per mo., and my Private Health Insurance (BCBS of TN)would not pay for it if it was prescribed as "maintenance therapy" for opiate addiction in a Methadone Clinic setting. However, they will pay for Methadone if it is prescribed for pain relief and filled through a regular pharmacy.

My question is this: How could they deny to pay for it when my Dr. was so adamant that I had no other options? Especially after being told I was putting my child at serious risk for death if I didn't comply!

Since addiction is now recognized as an official disease, it also seems discriminatory that the exact same drug is covered for long-term pain management, but then it is denied for another condition. Many studies over the last 30 (or more) years have also shown it's an effective way to treat opiate addiction. It doesn't seem acceptable. Do I have any recourse to appeal for a payment?

Just as an update: By the grace of God, my son is a now a healthy three year old. I also managed to get off of the Methadone a little over one year ago.