I wanted to start with this link above so that you see it and hopefully read it. If you are close with someone who has gone through substance abuse issues lately then you may know a thing or two about what thousands of addicts are dealing with each day. As if getting clean isn’t hard enough, their insurance company’s are creating the biggest barriers of all.
Let me give you a few first hand experiences I came across when running substance abuse facilities. First, a client shows up for detox at an out of network inpatient facility that does detox and has checked his benefits prior to arrival and it looks like he can come in with insurance coverage and some standard out-of-pocket admissions fees. His insurance is one of the few that recently requires anyone going to an out-of-network facility to pre authorize their own treatment time. This is something that previously the treatment provider would do on their own. So a guy who is detoxing off heroin needs to call his insurance company and wait 30 minutes on hold to pre authorize time for him so he can get treatment. If that was only it! When the addict Spoke with a care manager on the phone they told him that they would deny any days at an out of network facility. Even though he met medical necessity and had out-of-network substance abuse coverage. When asked why they stated it “was too expensive and their was better cost effective opTions.” They gave him a list of places in the area that were in network with that insurance and told him they would authorize detox and approve an additional 21 days of inpatient rehab at one of those locations. Now to wrap up the horror, this guy flew in from out of state to go to rehab and now has to go somewhere he wasn’t planning or go back home dope sick. This particular case infuriated me realizing that people would have such disregard for human well being.
Here is another story that is a little different but none the less as gut wrenching. A client comes in for rehab and they need detox. Their insurance approves them for an opiate detox initially. After 3 days the client gets off withdrawal medications because they don’t want to stay on maintenance drugs for weeks and months to come. When the utilization team calls to authorize inpatient rehab the insurance care manager asks if the client has any cravings, which he finds in the notes provided by the medical staff. As is common yes the client has cravings after 1 day off medication. Because of this one answer that the client has cravings and has not been kept on craving medication the inpatient authorization is denied and they now need to leave treatment and attend an outpatient program. AFTER ONLY 3 days of treatment! The likelihood of this person staying clean has now been reduced to less than a 1% chance. All because they didn’t want to continue and addictive medication while in rehab.
These are just two brief stories. We could go on and on with nightmare insurance company stories as I’m sure many could. THE JIST OF THIS POST IS TO MAKE SURE YOU GATHER ALL YOUR INFORMATION AHEAD OF TIME; KNOW YOUR PLAN AND ITS BENEFITS. CALL YOUR INSURANCE COMPANY AHEAD OF TIME AND LET THEM KNOW YOU ARE GOING TO REHAB. YES THEY WILL TRY TO STEER YOU TO AN IN NETWORK FACILITY. Get educated on your rights as a customer and get the help you deserve and pay for. LET US KNOW HOW WE CAN HELP IN FHE PROCESS. THE LESS SURPRISES THE BETTER. AFTER-ALL, THE HARDEST PART IN GETTING CLEAN SHOULD BE GETTING CLEAN, NOT ALL THE RED TAPE IN DOING SO.