Major Health Insurance Plans Provide too Little Help for Substance Abuse Treatment

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St. Joseph Institute reports about a recent review of major health insurance policies revealing a growing number have adopted admission guidelines preventing people from going to drug and alcohol rehab. Facilities across Pennsylvania, and around the country, have reported that insurance providers are limiting entrance to residential treatment centers by using very strict eligibility criteria. In 2011 more than 800,000 people sought but could not afford addiction treatment; a significant percentage of this group had insurance plans that denied access to drug and alcohol rehab.

A recent review of major health insurance policies reveals that a growing number have adopted admission guidelines that prevent people from going to drug and alcohol rehab. Facilities across Pennsylvania, and around the country, have reported that insurance providers are limiting entrance to residential treatment centers by using very strict eligibility criteria. In 2011 more than 800,000 people sought but could not afford addiction treatment; a significant percentage of this group had insurance plans that denied access to drug and alcohol rehab.

“Every day we speak with families who think they have a good healthcare plan with strong benefits for substance abuse,” stated Michael Campbell, president of St. Joseph Institute. “They obviously become very upset when we explain the fine print in their policy may limit coverage or makes them ineligible. Health insurance companies are using a variety of techniques to severely limit access to drug and alcohol rehab.”

The review found that the two most common ways in which coverage is denied are through restrictive medical criteria or what is referred to as “fail first” requirements. These restrictive medical criteria demand that someone has a very serious addiction problem, mental health symptoms, and a medical condition that has the potential to seriously damage their physical health. While the majority of people suffering from addiction meet most of these requirements, many are not in imminent medical danger from conditions such as pancreatitis, seizures or heart attack. Consequently, their health insurance plans deny entrance to residential treatment centers, or approve only a few days, requiring these individuals to leave treatment before the real work of addiction recovery can begin.

The second common way insurance companies deny coverage is by requiring that the individual first attend and fail an outpatient program. This “fail first” requirement is not applied in any other area of medicine and health care. Using this requirement, insurance companies can ignore the severity of the addiction or associated mental health issues, and deny access to drug and alcohol rehab, even though it has a much higher success rate than an outpatient program. It should also be noted that this requirement is in violation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This Federal law, the full implementation of which has been repeatedly delayed, prevents insurance companies from imposing eligibility criteria for mental health addiction that would never be applied to a physical health problem.

We hope to see changes in these policies soon so that insurance companies treat people with addiction in a fair manner and allow them access to the drug and alcohol rehab they need.

St. Joseph Institute is recognized as a leader among residential treatment centers for its innovative programming. Its addiction rehab program emphasizes the importance of identifying and addressing the underlying causes of addiction, and helping people find lasting solutions. In contrast to most addiction rehab facilities, the Institute’s programs are highly personalized, focusing on the needs of each resident. Treatment includes individual and family counseling, educational seminars, bodywork, fitness, 12-Step programs, meditation, discussion groups, and state-of-the-art nutritional therapies to support recovery.

For Information:
Michael Campbell
814-692-4954 ext: 111

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Michael Campbell