The Insurance Nightmare

The "Addictions" documentary recently released by HBO has definitely underscored the escalating drug and alcohol use among adolescents and adults. Contrary to what some people would like to believe, alcohol and drug use is on ...

Print Email

The "Addictions" documentary recently released by HBO has definitely underscored the escalating drug and alcohol use among adolescents and adults. Contrary to what some people would like to believe, alcohol and drug use is on the rise and out of control in many arenas. The documentary is both informative, challenging and disturbing. It underscores the complexity of addictions and the lack of real substantive treatment for people in need.

The use and abuse of alcohol and drugs has not lessened, what has changed is people's attitudes. Many people are much more tolerant of drug and alcohol use and abuse. A growing number of parents see it as a rite of American passage for their adolescents. They tend to be more tolerant around experimentation and see it as part of the growing experience. There is a real danger with that attitude.

Too many young adults think they have the right to smoke weed recreationally and drink socially, especially if they are compliant with parental directives and are reasonable students in school. The common attitude is, "What's the big deal? If I'm safe and not hurting anyone, what's the problem?"

This kind of thinking is potentially dangerous. Our teenagers grow up with a mixed message around breaking the law and using chemicals that are potentially harmful and in some combinations, even lethal. We live in a culture that tends to glorify and celebrate being stoned and wasted. It is no longer seen as the exception, but rather as the norm.

A growing number of parents are becoming alarmed at their children's social behavior. Every day we read another article about an adolescent who is under the influence and acting recklessly. Upon further inquiry, we discover that said adolescent has been experimenting with illegal substances for a long time. He was flying under the radar until he got caught. Finally, his parents saw that he was out of control and on the verge of total human destruction.

They panic and don't know what to do! They confer with a family internist who suggests that they take their son for a drug and alcohol evaluation. As a family, they do not know where to turn. Where do you go for such an evaluation?

They have pretty comprehensive insurance. They quickly discover that even though they have a very extensive and expensive family plan, it does not cover mental health or drug and alcohol rehabilitation. They are all shocked and deflated. They call their broker and complain about their poor policy.

The fine print indicated that a person with an addiction problem should try outpatient services first, before residential care could even be considered. Clearly, insurance carriers don't have a clue about addictions and the affected treatment modalities for this very serious disease.

Too many insurance companies decide over the phone, whether or not you are eligible for treatment. More often than not, they want you to use outpatient treatment first, and fail, before they will consider any kind of residential treatment. What most insurance companies don't realize is that their approach could take someone's life.

Some addicts who are out of control don't have a week to get it together, use local resources to get back on track and ultimately get better. They are usually out of control because of their addiction and have a very hard time entering recovery on their own. Do insurance companies have the right to play with another's livelihood and well-being? Candidly, they don't! But, we literally allow them to get away with murder!

Managed care is a disaster and a scandal. We live in the richest nation in the world and we still do not have comprehensive national health insurance. How many working families don't have insurance because they work a job that does not offer health care, and they cannot pay for it on their own? So, they navigate life's complicated landscape uninsured. Not only are the poor victimized because of poor and/or no health care, but the working middle class are equally being challenged and coming up short when it comes to health care. They either have limited health care that is grossly inadequate or none at all. They pay as they go.

Paying as you go is a nightmare. A growing number of people are not going to seek medical treatment, mental health treatment and/or substance abuse treatment, because the costs are outrageous. Even a sliding scale for services rendered is ridiculous for the average middle class family.

Those who have Medicare and Medicaid or government insurance are finding fewer and fewer venues that will accept those forms of payment for services rendered. Some people with serious medical problems are going untreated.

Managed care has effectively destroyed long-term residential treatment for addictions. In the metropolitan area, there are almost no treatment opportunities available for the poor and the working poor.

If the person is a hard-core heroin or vicodin addict, a short-term detox and outpatient program are going to be grossly inadequate to help that young person enter recovery and succeed. To the contrary, the short-term band-aid approach is not only ineffective and destructive, but in the final analysis, much more costly.

Thus, where does a struggling addict, with no insurance, go for treatment? If one is fortunate to find a treatment program, usually, there is a waiting list. Where does the addict stay in the meantime? How does he apply for Medicare or Medicaid?

If he's fortunate enough to find an advocate to work with him, there is still no guarantee that he will receive the government insurance he is eligible for. It almost seems that the government purposely sets up the working poor, and the street poor for failure. The protocol for applying for government insurance changes on an on-going basis; you can call a local Medicaid or Medicare office, talk to three workers and get three different responses to your questions. Usually, after all is said and done, you still do not get the correct response.

If this sounds frustrating, trust me, it is that and so much more! Well-educated people who are trained in the field of human services and social services find it almost impossible to navigate our system.

JD is twenty-five years old. He's a hard-core alcoholic. After a binge that lasted days, he finally agreed to residential treatment. He sought treatment in a local medical facility. He received excellent medical and addiction treatment.

When he entered treatment, a social worker met with him regarding payment, since he had no insurance. He was told that he was eligible for Medicaid. They began the initial process. He was told that he would probably get approved and Medicaid would cover all of his expenses.

Due to the seriousness of this disease, he was kept in treatment for forty days. Upon his discharge, his Medicaid case was still pending. A few weeks after discharge, he was informed that his case was denied because he made too much money. He was never informed of that issue when he began treatment. He asserts that he would never have committed himself to treatment, if he knew that he would have to pay out of pocket for it. His present bill is in excess of $140,000.00. Portions have already been turned over to collections agencies.

Each time he tries to handle this dilemma like a mature adult, he ends up in a maze that consumes hours of his day and leads nowhere. He is self-employed and uninsured. He has lost days of work trying to resolve a problem that could have been avoided, if he was properly informed and cared for, as he began treatment.

The recidivism rate for drug addicts and alcoholics is epidemic. Being hit with a bill you are ill prepared to face is a sure ticket to relapse! What will it take for the system to be more committed to people getting better rather than caving in to the politics of managed care and the insurance industry?