$300 a month or $16 a day: Financing addiction treatment in Northeast Tennessee

Zach Vance • Updated Oct 21, 2017 at 11:21 PM

Opioid addiction can ravage a user’s family, destroy lifelong friendships and deter career aspirations, leaving countless trials and tribulations in its wake.

But once an opioid addict does commit to recovery, another burden presents itself: financing costly treatment with little or no help from health insurance providers.

Despite its controversies, medication-assisted treatment, used in conjunction with counseling and group therapy, is widely regarded as the most effective way to treat opioid addiction within the medical community.

Typically, methadone treatment costs anywhere from $10 to $16 a day, while buprenorphine costs about $300 a month, although financing either option can be a barrier for low-income addicts seeking relief.

“Treatment is expensive, whether it’s abstinence-based, methadone or buprenorphine. It’s all expensive,” Paul Trivette, executive director of the Tennessee Recovery Coalition, said. “But if done properly, that expense can be justified.”

In the Tri-Cities, finding an addiction treatment provider that accepts any type of health insurance can be cumbersome.

Trivette said he knows of just two local buprenorphine providers who accept insurance, although many doctors will work with low-income patients to get them treatment.

The reason most buprenorphine prescribers don’t take insurance, according to Trivette, is ridiculously low reimbursement rates.

“I’ve seen TennCare reimbursements ranging from $7 to $70 per visit,” Trivette said. “If you’re doing everything correctly within one of these clinics, you’re hiring counselors, case managers, doing drug testing and everything you’re supposed to, you can’t survive on that type of reimbursement. The reason is because most of your patients will probably be TennCare recipients.”

Trivette said Dr. Leslie Cole, who opened a treatment practice in Franklin, Tennessee, accepted insurance for buprenorphine treatment and had to close within six months due to low reimbursements. 

On the other hand, TennCare does cover the cost of generic buprenorphine medication, as long as it’s prescribed by a doctor in the TennCare network. 

As far as coverage for methadone, Medicare Part D does not cover it if it’s dispensed for opioid dependence, but TennCare does for enrollees between the ages of 18 and 20 years old.

On Sept. 18, East Tennessee State University and Mountain States Health Alliance opened the Tri-Cities’ first comprehensive addiction treatment clinic that dispenses methadone, called Overmountain Recovery.

Currently, Overmountain does not accept health insurance, but the clinic’s goal is to eventually contract with as many in-market insurance providers as possible, clinic administrator Lindy White said.

“It is a process. You have to apply and then there is the process of negotiating the terms and conditions of that specific contract. It’s a little more straightforward with our federal payers,” White said. “We do anticipate and hope to have some of those payers available by the end of our first fiscal year, which ends June 30, 2018.”

While other addiction clinics around the state do accept insurance, White said she is hoping to negotiate a “bundled” policy that will cover all of Overmountain’s services, including its medication, therapy, counseling and social services.

Overmountain Recovery currently charges patients $16 a day for treatment, not including a variety of other fees for initial evaluations, take-home bottles and lab tests.

In its certificate of need application, approved by the state’s Health Services and Development Agency last year, Overmountain officials said the methadone treatment would cost patients $13 a day. 

“With any certificate of need (application), you typically file that a year or two in advance of the actual opening of the service. This is a new service to us, so we didn’t have a lot of comprehensive details or historical data to go from,” White said.

“As we started to put the pieces of the program together and did our due diligence in regards to cost of care associated with our program, we landed at the $16, which was just a few dollars above what we anticipated in the certificate of need. I will say that (the cost) is very comparable and is a fair-market rate as you look at other clinics in the state.”

Considering the $13 per day cost estimation, officials also projected in its application that the clinic would lose $326,421 during its first year, a loss White said is still expected despite the $3 in extra charges per patient per day.

“(We’re) definitely still anticipating a gap because of the front-end loaded cost associated with opening the clinic,” White said.

Overmountain Recovery does provide discounted rates if patients pay account balances a week or a month in advance, dropping the cost of treatment to around $14.40 per day.

On Friday, White said her clinic had admitted slightly more than 60 patients, with some benefiting from financial assistance offered through the clinic’s proprietor, Mountain States Health Alliance.

“This is about access to care. We do have a financial assistance policy. Within our health system, we actively seek to work with patients to bridge that gap between their ability to pay and the service,” White said.

Called “charity care” in hospital terms, Overmountain is projected to provide $78,000 in financial assistance, helping an estimated 32.5 patients, during its first year, according to initial projections listed in the clinic’s application.

To learn more about addiction recovery, visit www.overmountainrecovery.org.

Email Zach Vance at [email protected] Follow Zach Vance on Twitter at @ZachVanceJCP. Like him on Facebook at Facebook.com/ZachVanceJCP.