"You're not out of luck, but you face a lot of challenges getting help," said Dr. Eric Goplerud, the director of Ensuring Solutions to Alcohol Problems, which reviews state insurance policies for the Department of Health Policy at George Washington University in Washington, D.C.
If you live in Connecticut, Delaware, Indiana, Kentucky, Minnesota, New Jersey, Vermont or Virginia, you're fortunate. Laws there require that insurers treat alcoholism as a chronic disease, offering coverage equal to that for diabetes or cancer.
But there are nearly as many states where you're virtually unprotected. In Arizona, Idaho, Iowa, Oklahoma and Wyoming, insurers aren't required to pay for treatment and recovery programs. There is little uniformity in the rest of the nation, but coverage is minimal.
For starters, co-payments for addiction treatment are severely curtailed. Under the strictest of policies, you're expected to pick up as many additional doctors' visits as necessary, and if you need the extended treatment recommended for a good chance at recovery, most carriers will pay for no more than a month at the top end. If you need help for the mental or emotional health issues often paired with addiction, your co-payments go even higher.
Uneducated views about the causes of substance abuse actually have resulted in steady erosion in coverage, Goplerud said. Insurance companies today pay roughly 25 percent of all claims related to alcohol and drug addiction treatment and recovery expenses, down from a third as recently as 1991. The balance is largely absorbed by public sources, like Medicaid, and the affluent, who can dip into their own pockets for customized treatment.
Treatment and recovery providers are stepping into the void, offering help in determining how much coverage you're entitled to and where to find it. Some centers even provide "scholarships" or other financial help.
In the workplace, corporate benefits officials still balk at paying for substance abuse- related expenses. Stubborn attitudes contribute to the discriminatory policies.
Last fall, Goplerud conducted four focus groups with corporate executives and benefits managers about the coverage offered for substance abuse treatment in company-sponsored health plans. While most of the participants said they were aware of the research linking biological factors to addiction, "You don't have to scratch too far below the surface for them to say they aren't sure they want to pay for 'bad behavior,' " Goplerud said.
A handful of companies has come up with enlightened benefits, policies and practices. Quad Graphics, a large, private commercial printing company in suburban Milwaukee that prints Newsweek magazine, offers employees with addictions 24-hour access to health care professionals.
Antiquated laws also play a role in limited financial support and access to treatment. Thirty-two states still enforce statutes -- the Uniform Accident and Sickness Policy Provision Laws -- enacted in 1947 that allow insurance companies to refuse payment to hospital emergency rooms if an alcohol- or drug-related trauma brought you there. To get around the payment issue, doctors may not report the substance abuse, so those who need treatment don't get it.
Goplerud, whose center tracks, among other trends, the financial impact of alcohol addiction, calls these "bad laws." Four states and a number of leading medical and physician-led organizations agree; they've called for their repeals.
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