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Are insurance companies dropping the proverbial ball

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What if you or a loved one was suffering from a drug or alcohol addiction and tried to enter an addiction treatment center only to learn that your insurance claim was declined?

Well, many leading drug and alcohol addiction treatment centers have been reporting that this sort of consumer un-friendly scenario is playing out all too frequently with insurance policy holders who are being denied coverage for their drug or alcohol addiction as well as mental behavioral condition.

Where’s Obamacare?

Ironically, the American Affordable Care Act (AFA), aka Obamacare was supposed to provide more coverage for people seeking alcohol, drugs, and mental health treatment. One of the key components of Obamacare is the Mental Health Parity and Addiction Equity Act that requires insurance companies provide drug, alcohol and mental health care in their policies.

So what has gone wrong?

Well, for starters, while the mandate sounds great in theory – the legislation has not panned out as of yet. Since the “essential” benefits were not spelled out clearly to insurers in the mandate - it has conveniently provided a loophole for many insurance companies to opt out of the responsibility of making these types of claims available.

Drug/Alcohol Addiction Treatment Centers – Nothing has changed

According to a recent USA Today article, despite the new Obamacare coverage and protections, treatment centers are still battling with insurance policies over the length of time their patients can receive care.

"There is that natural tension between a payer and a provider that continues," said Les Sperling, chief executive officer of the Central Kansas Foundation, an addiction treatment facility.

At the Impact Drug and Alcohol Treatment Center, company sources said they continually are attempting to convince insurance providers to provide more coverage days. "We have to paint a picture for the insurance companies of this sick person who needs a lot more help," said Mark Paquet, admissions director.

Legalization and non criminalization of marijuana isn’t helping matters

As if the consumer did not already have their hands full trying to find an insurance company to help treat their addiction – there is now a growing list of states that are either flat out legalizing or decriminalizing marijuana – adding another crimp to the consumer’s inability to receive or extend insurance claim coverage.

Despite the fact that teens, who are trying to enter a drug rehab, are legally underage to use marijuana - more and more insurance companies do not consider teen marijuana drug abuse to be significant enough of an issue to even warrant insurance coverage. This logic does not make sense especially since its deleterious effects have been well documented.

“As a leading teen treatment center owner, I am concerned at the state of insurance coverage for some of the most vulnerable people in our society – those trying to take back their lives by making the brave decision to enter an addiction treatment program,” said Karen Corcoran Walsh, president of Inspirations for Youth & Families Teen Treatment Center. “Insurance companies need to understand that addiction is a disease just like any other serious health condition and step up to the plate to support their policy holders.”

Coming up next:
Can a Class Action Suit against a large insurance company provide relief to policy holders or create a chilling effect for those seeking drug, alcohol and mental behavioral treatment?

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