Holding Insurance Companies Accountable


While waiting on a crowded screening line at Islip McArthur Airport, I met a mother I knew from the North Shore. I had helped her son when he was sixteen. He was now thirty. He ...

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While waiting on a crowded screening line at Islip McArthur Airport, I met a mother I knew from the North Shore. I had helped her son when he was sixteen. He was now thirty. He was still struggling with many of the same issues that he wrestled with when he was a teenager.

However, now as an adult paralyzed by reckless decision making he has fewer and fewer resources to help him get control of his life.

TK is a young man who was adopted into a family of privilege. His parents were present and attentive. They never walked away from their responsibilities as parents. More than many of their peers, they always went the extra distance on behalf of TK.

They fought for him at school CSE meetings to be sure he got the appropriate services as a learning disabled student. He went to the finest therapists around to help him cope with his social and emotional challenges.

As a high school student, like many of his peers in the crowd he hung with, TK started to smoke pot and drink. Unlike his friends, he always got caught. These social behaviors clearly impaired his decision-making.

Each time he got caught and was confronted with his behavior, he swore he would stop. He didn't. He became more proficient at being a sneak, but that only lasted a few months at a time. Again, he would get caught.

By the time he was twenty-one, he had been in and out of a half a dozen rehabs. By his twenty-second birthday, he was an expert on the recovery lingo. He could convince you that he was the most outstanding "poster child" for recovery on the planet.

Unfortunately, what became clear to his parents by TK's late teens and early twenties was that TK clearly possessed an addictive personality. He needed to abstain from all chemical substances. He could not occasionally smoke weed or drink a beer, because each occasion plunged him right back into binge smoking and drinking.

During that phase, he was more vulnerable to trying other more dangerous substances like crack and cocaine and his relapse mode lasted a little longer.

No matter how many rehabs TK spent time in, not matter how good his recovery lingo was, it was still hard for him to accept that he is powerless over his disease and can never drink or smoke weed again.

I listened to TK's mother retrospectively review her adult son's life. She spoke with a mother's love about her frustration with a system of treatment that really sets people up for failure.

Rehab after rehab waxed eloquent that they were the state of the art facility with the most comprehensive network of services to help the patient fully enter recovery.

In their printed and video propaganda, they highlighted their beautiful campus facility and listed the services that would be available. What they did not explain was their position on insurance companies and how when your insurance ran out, no matter where your son or daughter was in treatment, he or she would be discharged with little or no notice to the family.

Sometimes, if you yelled and screamed enough, you might get a few days reprieve, but that was rare. You were always told that you could pay out of pocket and that their institution had a "wonderful financing plan." In small print, if you qualified, which in English meant if you had a house with good equity in it or some money in the bank, you had a shot at approval. However, cold cash was better.

Most insurance companies then and now set up the average, hard-core teenage substance abuser for failure and continual relapse. Their provisions are not shaped around good treatment objectives, but rather cost effective planning. What does it really matter if the insured is not helped and only set up for disaster?

Thus, those who have the power over your life and ultimately your recovery for the most part are clueless. The initial approach insurance companies take to teenage addiction is intense outpatient treatment. For the motivated teenager struggling with addiction that can be a very powerful tool and an excellent venue into recovery and wellness.

Unfortunately, for the majority of teenagers with serious addiction problems that approach is every parent's nightmare. First of all, most teenagers are resistant to any form of treatment. If they even admit to having a problem they will forcefully say that they can take care of business on their own. They don't need counseling or groups. Therefore, it is a struggle and usually a fight to get them to go anywhere.

After that is tried and money is lost, your insurance carrier might possibly approve a brief stay in a rehab. More often than not, it is just for a few days, maybe a week or two. Usually when they are just settling in, they get discharged.

Most programs will have an elaborate after care program for the resistant, non-cooperative teenager. You don't have to be an expert on teenager behavior to know that process fails miserably. Most teenagers in early recovery need to connect with competent therapists and young people's recovery groups. Both are hard to come by.

If the teenager is in high school and wants to return to high school, too often there is no support. Few schools have twelve step meetings on campus or mental health staff available to work with students in recovery. And we wonder why the recidivism rate is so high.

TK, as an adult is finally in residential treatment by choice. After spending tens of thousands of dollars out of pocket for her son's recovery, the latest frustration for his Mom is that after paying for his insurance so he would have a comprehensive plan, she has found out he has no real coverage for what he needs. He was told he would get better long-term care on Medicaid.

What a nightmare for a parent who has always tried to do her best in regards to her son.

What a scandal. What reckless behavior on behalf of our insurance companies. Who will hold them accountable?