On paper, it sounded so good: all insurance companies had to provide substance abuse treatment and there would be no more discriminating against those with pre-existing conditions. What could go wrong?
Unfortunately, quite a lot. This shouldn't be surprising to those who understand that no matter the provisions, insurance companies are always going to find loopholes. In this case, the loopholes revolve around establishing incredibly high deductibles and eliminating substance abuse treatment from individual plans.
What The Addiction Experts Say
"I love my president but he got this one wrong," says Richard Taite, founder and CEO of Cliffside Malibu. "Not because his soul isn't in the right place but because he went up against the House and the House always wins. When there's any type of dramatic change, they're somehow going to be able to create a windfall for themselves."
This means, in some plans, that deductibles for treatment coverage can be as high as $25,000 -- a number many people still can't afford and which insurance companies clearly put in place in order to escape the burden of having to cover treatment. Even then, rehabs can't be sure how much coverage there's going to be. "If insurance doesn't kick in until we've billed $25,000 worth of services, that can mean that we're footing the bill for the first two or even three weeks," says Howard Samuels, Founder/CEO of The Hills Treatment Center. (Experts tend to agree that for many addicts, 90 days of treatment is necessary.) "In some situations," Samuels continues, "the insurance is going to tell them they'll only cover two weeks. If I have, say, six empty beds, I'll take that chance but it's always a risk."
Why Alcoholism Needs To Be Treated Differently
Another factor that insurance companies don't seem to take into consideration is that alcoholism isn't a disease like, say, cancer or diabetes or really any other disease in terms of how the sufferer deals with it. "Many addicts feel like they don't need treatment when they do -- or they change their minds about needing it," says a counselor who works with addicts. In other words, someone who was willing to go to rehab on Monday may not feel the same way by Thursday (or even later Monday) so timing is of the essence and treatment possibilities coming and going can mean the difference between a lifetime of continued enslavement to addiction or freedom.
And not all treatment programs are created equal. Insurance companies have now deemed outpatient the most effective (read: least expensive) treatment when that's simply not the case. "Outpatient programs are popping up all over the place because insurance companies are more likely to cover those for up to $1500 a day when they won't cover detox for $500," says the counselor who works with addicts.
Detox is a complicated issue when it comes to reasoning with insurance companies. "A lot of them will only cover detox for alcohol, benzos or opiates," says Samuels. "So that means things like Xanax and heroin and Klonopin are covered, but not crystal meth or cocaine because they've been deemed less addictive." (Try telling that to a person on a 14-day meth run.)
The Problem With Top Insurance Plans
An even bigger issue, for those willing to pay for the sort of individual gold standard insurance that used to give them substantial evidence-based treatment, is that California insurers stopped providing that as of the 1st of this year. "The entrepreneur or attorney working on his own -- people who were willing to pay the premium for the best possible insurance -- used to have the option of getting the best treatment," says Taite of Cliffside. "Because insurance companies knew that they were going to be losing a lot in terms of having to cover those with pre-existing conditions, they stopped providing real substance abuse treatment for individuals." What this means is that instead of full-time evidence-based treatment, those people now receive what's essentially, according to Taite, the equivalent of a sober living house. "They basically get three hots and a cot," says Taite. "This has taken substance abuse treatment back 30 years."
It's Not All Bad
Still, not all insurance companies are playing hardball. "Cigna and Aetna are some of the better ones," Samuels reports, adding, "Roughly 15 to 20 percent of insurance companies will pay a good amount for residential treatment." It's those companies that make Samuels "applaud" The Affordable Care Act despite its limitations. "Look, I'm able to bring in people that have no money and occasionally their insurance will pay for up to two months of treatment," he says. "But that doesn't mean that the PR campaigns insurance companies put out aren't bullshit." (To see where your insurance company ranks in terms of treatment, you can check your benefits here.)
It's Really Too Soon To Tell
Also, the so-called good guys are in the minority -- and the long-term impact hasn't yet been written. Says Taite:
On paper, is this helping more people? Yes, but is it in reality? Not yet. Yes, people who wouldn't have access to any treatment can get coverage at some of the less-expensive rehabs but they're not getting anything that takes full advantage of the evidence-based treatment we have today.
And the final story isn't yet written. "We're still at the beginning of this so we're not really going to know for another year how well it all works," Samuels opines. But Taite is concerned about what could happen next.
My fear is that insurance companies are going to notice the windfall they've created for themselves in terms of eliminating coverage for individual policies. Then, by 2015 or 2016, they'll decide to do to group policies what they've done to individual policies.
After a pause he adds, "As far as substance abuse treatment benefits are concerned, this is a loser."
This piece originally appeared on AfterPartyChat