We can help you understand your condition, learn about treatment options, and understand the importance of following your doctor's plan. There are no additional fees to participate in these programs.
Our clinical criteria listed below are evidenced based decision making guidelines. We also use guidelines from CMS (Centers for Medicare and Medicaid Services) and eMedNY when applicable.
Effective immediately, for our members with a primary diagnosis of moderate or severe opioid disorder, we will automatically approve all new requests received from New York providers for coverage (including preauthorization, if required) for an initial length of stay for the following services at any New York State facility licensed to provide such services without the need for a medical necessity review:
Requests for coverage of any additional days, or for services at facilities outside of New York State, will continue to be reviewed in accordance with our standard clinical review policies and procedures. To learn more or to request assistance from a Behavioral Health Advocate, please call 1-844-809-7518.
Information about substance use disorder treatment resources in New York State is also available at the website of the New York State Office of Alcoholism and Substance Abuse Services.