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Opiate update: Excellus suspends Gosy, AG sets up hotline, Cuomo forms task force

Action to address the opioid-heroin epidemic was taken on several fronts Tuesday from Albany to Buffalo.

The governor created a task address stopping the epdiemic.

Another health insurer took action against Dr. Eugene J. Gosy

A group of experts is arranging a program to provide free training on how to serve those suffering from addiction.

Excellus has suspended Dr. Gosy from its health care provider network. The suspension remains in effect pending a hearing to dismiss him from the network, according to Peter B. Kates, spokesman for Univera Healthcare.

“The other providers in his practice are not suspended … but the termination, if granted at the hearing, would be applicable to the entire practice,” Kates said.

That means Univera members under Gosy’s care will have to find another participating provider while the suspension is in place, Kates said, adding that they can contact their primary care physician or call the customer service telephone number on their member ID card.

BlueCross BlueShield of Western New York previously dropped Gosy and his practice, while Independent Health removed Gosy, but not his practice, from its network.

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Meanwhile, State Attorney General Eric T. Schneiderman urged state residents to call a special help line if they need assistance in gaining drug and mental health treatment through health insurers.

The attorney general’s “Health Care Helpline” number is 800-428-9071.

In the last two years, the attorney general’s Health Care Bureau has signed five agreements with health insurers, including Excellus Health Care Plans of Rochester, which operates as Univera Healthcare in the Buffalo area, that have recovered $2.9 million in penalties and obtained $1.6 million in member reimbursements for out-of-pocket treatment costs that should have been covered under parity laws.

Excellus was ordered to pay $500,000 for the cost of the bureau’s investigation of the company and provide 2,700 customers with the chance to appeal denials for inpatient substance use disorders and eating disorders. The restitution process continues, and 10 members have been reimbursed a total of $55,000 so far. With Univera, 59 customers were deemed eligible for the appeals, and only one customer sought the relief. The denial was reviewed and upheld by a state-assigned independent review agent, according to an Excellus official.

Schneiderman urged residents who receive denials to check denial letters for accuracy, ask health providers to submit letters of medical necessity “including facts that show that you meet the relevant medical necessity criteria point by point,” look for common improper denial flags such as “fail first” requirements, and check to see whether the insurer used criteria that do not match the health condition.

Gov. Andrew M. Cuomo announced formation of a statewide Heroin Task Force with the responsibility of developing a comprehensive plan to end the epidemic in New York. Its members will hold listening sessions across the state before developing recommendations.

Task force members include health care providers, drug policy experts, parents and individuals in recovery. Anne D. Constantino, CEO of Horizons, one of Western New York’s biggest drug treatment and mental health providers, was named to the task force.

On Saturday, “A Pastoral Response to the Substance Abuse Epidemic” is set for 8:30 a.m. to 11:45 a.m. at Christ the King Seminary in East Aurora. The free event will feature a series of speakers providing insights and skills to engage and assist individuals caught up in addiction along with their loved ones.

“This idea really took shape after conversations with people who want to help others, but who felt at a loss as to how to approach them,” said Sue Boyle of WNY United Against Drug & Alcohol Abuse. “So many people are suffering, not just those addicted, but also their families and friends.”

For information on registering, visit wnyunited.org or call 821-7722, Ext. 314.

The event also is being sponsored by the Office of Pro-Life Activities of the Catholic Diocese of Buffalo.

email: lmichel@buffnews.com