It isn’t uncommon. It is a story heard round the families of addicts. Sitting at a detox center, just waiting, desperate for the insurance company to approve the stay, the stay that could end up saving many addicts’ lives. But the insurance won’t do it. They are fighting tooth and nail to help you and I with our heroin habit, our Xanax problem, and even our drinking issues.
We sit and we wait. Sometimes 3 hours, sometimes 5 hours, sometimes 8 hours, sometimes 10 hours, sometimes a whole day to get into detox waiting on the approval of the insurance company. And it won’t come. Finally we hear word back that the insurance company just might give over the money to help us if we say we want to kill(harm) ourselves or someone else. What? We are drug addicts. And while many of us do feel like killing(harming) ourselves by this point, we don’t really want to. We especially don’t want to hurt someone else. So why do we have to lie about killing(harming) someone or ourselves? Well, the insurance company is more likely to approve you for benefits if you are mentally unstable AS WELL AS a drug addict. Being a drug addict often times, just isn’t enough. And unfortunately this kind of scenario is happening all over the country especially in New Jersey.
NEW JERSEY FAMILIES
Many of the individuals this is happening to are middle-class, suburban families-making them too wealthy to qualify for state or federal subsidies and too poor to pay out of pocket if insurance is denied.
Through dozens of interviews with parents, addicts, doctors, social workers, psychologists, and policy makers reveal that many patients are ready to commit insurance fraud to be admitted to inpatient rehabilitation programs. Some doctors and nurses tell patients to even drop their private insurance and get Medicaid or state grants or they tell them to lie about how much heroin they have been using, because the more that has been used, the harder it is for an insurance company to deny coverage.
WHY ARE INSURANCE COMPANIES LIKE THIS?
Insurance companies say they have good reasons for their practices. A clinician may want to err on the side of more treatment, regardless of what it costs. The insurance company can’t pay for everything without the whole system collapsing. Even critics a knowledge that insurance companies have to make a business decision. Excuse me? Insurance companies have to take a broader view to protect heir policy holders from paying outrageous premiums.
And as for advocates who decry that what they see insurance companies as doing is shortchanging the most vulnerable without ever having seen or spoken to the patient.
About 30% of the 33,000 heroin addicts who checked themselves into a New Jersey rehab facility are under 26 years old. These are middle class kids, many of whom attended college. They don’t peddle wares on street corners or shoot up in alleys like the most common picture of heroin addicts. They hide heroin in their parents suburban homes and use Facebook to connect with dealers.
It was recently reported that the number of New Jerseyans between ages 18 and 25 admitted to addiction treatment centers for heroin rose by more than 12% between 2010 and 2011.
Most insurance companies will pay to detox a patient but the ongoing care such as 30 or 60 day drug treatment aka the meat and potatoes of getting sober, is often seen as a luxury and not a necessity. And that is wrong.
TAXPAYERS YOU MAY WANT TO READ THIS NEXT PART!
Not only that but the struggles to find the right type and amount of care doesn’t only affect the addict it also affects the taxpayers. When private insurance doesn’t pay, it is taxpayers who pick up the tab either through emergency room visits or the criminal justice system. Studies from UCLA, the National Institute on Drug Abuse and others show that for every 1 dollar spent on treatment, 7 dollars is saved from the criminal justice system and health care system.
There are no numbers on how insurance companies do or don’t shortchange addicts but you can see it through talking to an addict’s family and the addicts themselves. People die because they can’t get help. All the time. And it is due to the insurance company in many cases. While waiting for approval, even for an extra day or two, can be the difference between life and death.
End of story.