Heroin-Driven Insurance Problems Grip New York and U.S.

photo of a syringe on top of a pile of heroin

New York legislators are grappling with how to deal with the plague of heroin that has been devastating suburban and rural youths statewide. The state, like so many others, has been struggling against heroin abuse for years, but the most recent development seems to be a cruel irony. Poorer families, so long the greatest victims of the drug trade, are actually in a better position to get treatment for addicted family members than more affluent ones.

The problem is that many private insurers refuse to cover long-term inpatient addiction care, unlike public low-income provider Medicaid. While the Patient Protection and Affordable Care Act (PPACA) includes a mandate requiring insurance companies to provide some form of coverage for addiction services, the mandate is inherently vague and leaves the details up to individual providers.

Several states across the country have taken legislative actions to try and curb this problem. They are looking for ways to get insurance companies to offer coverage for inpatient care, either through legislative mandates or in a compromise reached through open discussion.

Battling Addiction and Insurance

In theory, an insurance company is supposed to make life easier for individuals in need of medical services. In actuality, however, this is not always the case as many addicts looking for treatment often find themselves stonewalled by their providers. Many insurers deny coverage for rehabilitation deemed necessary by physicians, employing a controversial and unpopular “fail first” strategy. [1]

This approach gives addiction recovery patients the lowest level of care and requires them to fail first before the level of treatment is improved. Not only has this method proven ineffective for a large majority of individuals, it also falsely assumes that an addict will remain motivated to seek treatment. Many substance abusers have just one opportunity to get sober and save their lives. Requiring them to initially run through a gauntlet of ineffective treatment options is quite literally putting their lives in danger.

Thirty Days is Usually Not Enough

Even when addicts are granted addiction treatment at an inpatient facility, many insurance companies will not pay for more than 30 days of treatment. While a month may be effective for some recovering addicts, the general rule is that the longer the stay in rehab, the better the long-term results. Many industry experts and professionals recommend stays of at least 60 – 90 days for optimal results. [2] Most families aren’t in a position to pay for the extra needed addiction recovery services.

While both the ACA and Mental Health Parity and Addiction Equity Act mandate that insurance companies provide treatment for addiction and mental disorders at the same levels they provide for other medical conditions, loopholes, vagueness and poor enforcement have allowed insurance companies to dictate treatment as opposed to doctors. [3]

Several Treatment Options Available

Whether you’re looking for inpatient residential treatment, outpatient services or long-term addiction rehabilitation options, we can help. Contact the National Alcoholism and Substance Abuse Information Center (NASAIC) anytime at 800-784-6776 or through our online form and we will recommend the leading drug and alcohol rehab centers for you or your loved one.

[1] http://www.newsday.com/news/region-state/senate-bill-aims-to-expand-drug-abuse-treatment-1.7260151

[2] http://articles.latimes.com/2008/nov/10/health/he-addiction10

[3] http://www.rehabs.com/pro-talk-articles/a-law-without-teeth-the-reality-of-addiction-insurance/

Contact the National Alcoholism and Substance Abuse Information Center (NASAIC) anytime toll-free at (800) 784-6776 or through our online form, and we will recommend the leading drug and alcohol rehab centers for you or your loved one.

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