Consumer Guide and Scorecard Rates Health Plans for Addiction Treatment Coverage

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The California Society of Addiction Medicine (CSAM) releases a guide to evaluate insurance coverage for substance use disorder as offered by Covered California, the health insurance marketplace in California.

By sharing what we know about addiction treatment and have learned about current health care services in California, we hope to demystify addiction treatment and make the process of selecting an appropriate health insurance plan less daunting.

Under the Affordable Care Act (ACA), individuals can no longer be denied health insurance coverage for having a pre-existing condition like addiction. Additionally, the ACA establishes Substance Use Disorders and Mental Health treatment among the 10 Essential Benefits that newly sold health insurance plans must cover. With the advent of this new health care legislation, the California Society of Addiction Medicine (CSAM) saw the opportunity to educate consumers shopping for healthcare plans about where to find the best addiction treatment coverage.

To achieve that end and to coincide with the current Covered California open-enrollment period, CSAM has just released a report entitled “Consumer Guide and Scorecard for Health Insurance Coverage in California for Substance Use Disorders and Mental Health.” Reviewed by an expert panel of CSAM member physicians, the Guide and Scorecard rates the quality of and access to addiction care available through Covered California.

Utilizing the largest consumer tools available–the Covered California website, the 2014 bronze-level insurance plans from Covered California providers, and searchable, online information including websites and drug formularies, CSAM reviewed 16 plans from 10 insurance companies. “By sharing what we know about addiction treatment and have learned about current health care services in California, we hope to demystify addiction treatment and make the process of selecting an appropriate health insurance plan less daunting,” said David Kan, MD, a CSAM member and editor of the guide.

Although all Covered California plans now cover Substance Use Disorder and there is some degree of standardization in pricing policies, the report identifies several areas such as methadone treatment and pharmacy benefits, where there are significant differences among plans. Additionally, the report notes that plans with both higher and lower scores have distinct areas of strengths and weaknesses.

In addition to the scorecard, the report covers basics such as what you need to know about addiction treatment, information on coverage costs, and how to learn more.

“This guide is intended to be a living document, which will be updated periodically to reflect policy changes. While this is not a substitute for personally reviewing plan coverage, we hope consumers will find this guide a helpful starting point before making this important choice,” stated Kerry Parker, Executive Director, CSAM.

For more information or to request copies of the guide, visit: http://www.csam-asam.org

About CSAM: The California Society of Addiction Medicine (CSAM) is a professional society representing physicians dedicated to increasing access and improving the quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions. CSAM is a state chapter of the American Society of Addiction Medicine (ASAM).

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Kerry Parker, CAE, Executive Director
@csam_connect
since: 10/2013
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