When rehab might have helped but insurance didn't

When rehab might have helped but insurance didn't

A mom and dad in Philadelphia who lost their son to a heroin overdose have gathered nearly 40,000 signatures on a petition on the popular moveon.org petition website. Cris and Valerie Fiore’s petition calls for amendments to the Affordable Health Care Act to provide longer drug rehabilitation and treatment coverage. Their son Anthony, a brilliant student just setting out on his college career, fell victim to OxyContin and soon afterward had moved on to the more-affordable heroin. A few months after three stints in rehab, two for the 21 days the family’s insurance provided and a third for only 11 days, Anthony died from a heroin overdose. The family is convinced that Anthony could have had a real chance at recovery if he’d had at least the 90 days in rehab recommended by most experts across the country. The family’s insurance at the time, Premera Blue Cross, would cover only 21 days. In a written response to a reporter for National Public Radio’s Weekend Edition, the insurance company said that its “medical policies are informed by national experts.” We don’t know what experts Blue Cross was talking to, and we’ve never heard such nonsense. Of course, everyone progresses through treatment at their own rate, and there is no official predetermined length of treatment. But according to the most authoritative body in the country, the National Institute on Drug Abuse at the National Institutes of Health, U.S. Department of Health and Human Services, and we quote: “Research shows unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness in maintaining positive outcomes.” We added the italics to make the point – less than 90 days is of limited effectiveness – so what does that say about the insurance company experts recommending 21 days? Nothing of value.

Insurers must treat addiction like other illnesses

Under a 2008 federal law, insurers must consider drug and alcohol addiction the same as any other medical problem as far as access to treatment goes. The Department of Labor says it has investigated at least 140 claims in which such patient rights were violated. So far, all claims have been “resolved” through discussions with the insurers, the agency said. But advocates for adequate treatment say the actual information about these cases hasn’t been made public. And no fines have been issued against any insurers who violated the law. Deb Beck, of the Drug and Alcohol Service Providers Organization of Pennsylvania, told NPR that the situation the Fiores faced is common. Treatment facilities are in a constant battle with insurers for longer coverage. “The whole thing about who is worthy to have insurance coverage gets tangled into this,” Beck said. “But if I had a heart problem, and I didn't do everything I was supposed to, I would not be denied coverage. In fact, if I got sicker, you would increase the coverage for me.” Hopefully, grass roots efforts like the Fiore’s petition will bring about some changes in the insurance industry. Meanwhile, those of us in the field of drug and alcohol treatment continue to do our best to help victims of prescription drug abuse and heroin addiction, like Anthony Fiore, complete a successful detox and get into a lengthy rehab to get their lives back. Call Novus if you need help with a substance abuse problem. We can help answer your questions about addiction and detox, and help get you or your loved one on the road to recovery.

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