Insurers fall short when it comes to covering substance abuse treatment

Many health insurance companies are feeling the heat from consumers after they learn that their plans won't cover services for substance abuse counseling.

The parents of a man who died of a heroin overdose points out that because drug addiction isn't treated like a chronic disease, insurers often don't fully cover treatment options, NPR reports.

During their son's 21-day stint in rehab, Cris and Valerie Fiore's insurer, Premera Blue Cross, covered the costs. But once treatment was finished for the allotted time, Premera would not cover a longer stay, and the family could not afford to front the bill.

When insurers make a decision about whether to pay for treatment, Clare Krusing with America's Health Insurance Plans tells NPR that ultimately, they are looking for effectiveness. "It's taking into account the patient's health and how they respond to those treatments," she says. "There are many cases where, if patients need additional care and support, that is provided to them."

Often, treatment facilities battle insurers to cover longer stays for patients, Deb Beck, who represents the Drug and Alcohol Service Providers Organization of Pennsylvania, tells NPR.

Under federal law, insurers must treat drug and alcohol addiction the same as a medical condition. But it's hard for insurers to compare treatment plans, Krusing says. Many insurers also may be finding ways around the mental health parity law. 

Insurers could salvage the issue by recognizing a longer inpatient stay that allows people to break away from bad influences, Sam Ball, CEO of CASAColumbia, a substance abuse and addiction research organization, tells NPR.

Recent findings show that 33 percent of consumers received denials of authorization for mental health or substance abuse treatment from their insurer. And exchange plans had denial rates nearly twice the rate for other medical care, FierceHealthPayer previously reported.

For more:
- here's the NPR story

Suggested Articles

CMS expects Medicare Advantage and Part D payments to rise by 2.82% in 2022 after taking into account several regulatory changes.

While the rush to telehealth adoption may have slowed a bit from its highs early on in the pandemic, the data show consumer interest in virtual care.

Telehealth giant Teladoc completed its massive $18.5 billion acquisition of Livongo, the company announced Friday.