How Inadequate Insurance Coverage Kills Addicts

A guest post by Rose Lockinger
Addiction is a Progressive Chronic Disease.

Of the millions of people struggling with addiction who desperately need treatment, it’s estimated that only about 11% of them get it. And, of those who do get treatment, at its best mediocre and inadequate at its worse.

It’s not supposed to be this way. When The Mental Health Parity And Addiction Equality Act was passed. It’s intent was to improve access to addiction services and and address the lack of care people were facing. There have been improvements albeit the changes are not large enough to impact all those in need.  Much is left to be done by future Acts.

How Health Insurance Fails To Provide Adequate Care

Recovering from addiction isn’t an overnight process. It can take months of treatment, followed by extensive aftercare for a person to recover. Unfortunately, this level of care is rarely covered by most insurance plans.  They have the audacity to state they are responding to their clients needs.  However they blatantly disregard the recommendations of therapists and doctors.

Most people are accustomed to the common 30 day rehab center. While there are treatment centers that offer 60, 90 or even longer treatment stays, 30 days has become the norm. Why is this? Thirty day treatment programs exist to accommodate the limited coverage offered by health insurance plans for addiction treatment. Perhaps the most angering component here is that NIDA plainly states that even 90 day inpatient stays are rarely effective for opiate addicts and from personal experience any addiction.

Not only that, but many insurance companies will not even cover the cost of a full thirty days, so if you want to complete the program, you may end up paying for up to half of the cost, or go home.

How Long Does It Take To Recover From Addiction?

There are no hard and fast rules here, each person is different. While one month of treatment isn’t ideal, it is better than nothing, and people who are motivated to change their lives may find that the 30 days of treatment gives them the start they need to begin their recovery.

One of the problems being faced today is that the opiate addiction epidemic is changing the needs of persons who are struggling with addiction. Someone addicted to painkillers or heroin must first undergo a detox. This requires minimum of three days, but more ideally 7 – 10 days in order to recover from withdrawal symptoms. This may be covered by insurance, but after a  drug detox, continued treatment is necessary to combat the powerful psychological addiction that leads to relapse. This may or may not be covered under insurance.

For someone who is addicted to opiates, a 28 day “spin dry” is not a sufficient level of care. People are discharged far too early from treatment, only to find themselves right back in — if they make it. Many of these short-term treatment facilities are a revolving door.  With deaths from overdose a reality for many former clients.

Hazelden took a brave step forward in 2012 by adding buprenorphine to its treatment protocol  for opiate addicts.  This is a big step in the right direction.  There is research to support that this is an effective measure.  The key being that over time they are weaned off.  This buys them time to heal while the needed services are commenced.  Time is key, healing doesn’t happen overnight and even after 24 months of abstinence the brain is still healing.

Insurance Companies Regularly Deny Treatment

Despite the fact that the Mental Health Parity And Addiction Equality Act was set in place to prevent discriminatory denial of access to care, it still happens. While a person with heart disease or diabetes wouldn’t be denied care, addicts are regularly denied coverage for the treatment they so desperately need because it’s not been deemed “medically necessary.”

The cost is a human toll of countless deaths of those who are unable to get access to care, or who are discharged from treatment centers before they are ready.

Insurance companies will naturally argue with this, citing that they base their decisions on criteria set forth by medical addiction professionals, and that part of the problem lies with the difficulty in diagnosing who does and doesn’t require additional care. There is some truth to this. It isn’t cut and dry. One person may very well be able to achieve addiction recovery through attending a month-long program, but given the statistics on addiction recovery and relapse today, it’s plain to see that those cases are the exception, not the rule.The longer and more comprehensive the addiction treatment, the more likely that the person will be able to achieve long-term sobriety. What does adequate addiction treatment look like? A thorough detox, inpatient treatment that doesn’t end after 30 days. Comprehensive outpatient aftercare. 30 days or less is simply not sufficient to address the needs of a person who is fighting an illness that can and will kill them if left untreated.

Bottom line, in order for people to have the best possible chances at recovering from this deadly disease, adequate care should be available whether they want it or not. This means not discharging people from treatment before they are ready. This means providing quality care, and it means providing continued support services to newly recovering addicts just out of treatment.

How Early Intervention Can Help
Early identification and intervention also needs to be part of the solution. Getting people into treatment early on instead of bouncing them around the system, jailing them or otherwise ignoring the problem can make a difference and save lives.
On a personal note I know what it is like to seek treatment early on and only receive minimal treatment. At 17 I spent the last portion of my Junior year in a hospital.  I was only covered for 5 weeks of inpatient treatment and back home I went.  The rationale behind this included the fact that I was not underweight, I was bulimic and at that point anorexia was always considered more dangerous. I was terrified of going home I told them I wasn’t ready but Insurance companies don’t care.  Every day of treatment is a fight to keep a client there.
I would like to say that honestly maybe I would not have had to spend the last 17 years fighting not only an eating disorder but also addiction.   What would my life look like today if I had received 6 months of inpatient vs 5 weeks.  I was highly motivated to get better I just needed the PTSD and trauma addressed and that was not happening in 5 weeks.   Because they knew even back then they knew that the neurotransmitter release during a binge purge session was similar to that of heroin.  So seriously you think that 5 weeks is long enough. NO!  I hope that someday insurance companies will not be able to continue with the way they do business.
The country is facing a crisis, and it must be addressed, or people are going to continue to die.
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
http://www.baldwinresearch.com/addiction-treatment-insurance-coverage.cfm
http://www.npr.org/sections/health-shots/2015/08/16/430437514/when-rehab-might-help-an-addict-but-insurance-wont-cover-it
Rose Lockinger is passionate member of the recovery community. A rebel who found her cause, she uses blogging and social media to raise the awareness about the disease of addiction. She has visited all over North and South America. Single mom to two beautiful children she has learned parenting is without a doubt the most rewarding job in the world. Currently the Outreach Director at Stodzy Internet Marketing.
Rose
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