Do Insurance Companies Discriminate Against Addicts?
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Do Insurance Companies Discriminate Against Addicts?

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According to Valerie Fiore, they do. That’s why the Philadelphia mom, who lost her 24-year old son last year to a heroin overdose, is fighting for the Affordable Care Act to enforce the 2008 federal law requiring insurance coverage for addiction comparable with treatment for any other disease. If they had—covering longer treatment for her son’s third stint in rehab—he might still be alive today.

Like Any Medical Treatment, Rehab Offers No Guarantees

Or he might not. Unfortunately, that is the tricky part about addiction treatment, nothing is guaranteed. This could be why many insurance companies have put the kibosh on covering long or multiple stints in rehab; the success rate (in overall statistics) is just not high enough. But as some have pointed out, few medical treatments are 100% guaranteed to be effective.

Deb Beck, a representative from the Drug and Alcohol Service Providers Organization of Pennsylvania, notes that if she had a heart condition, even if she didn’t do everything she was supposed to do to improve it change her diet, exercise more, lessen her stress load—she would not be denied coverage for treatment. It doesn’t seem fair to not extend that same policy to addicts.

When you think about it that way, it’s hard not to see that there is still a stigma when it comes to addiction, even on the corporate level. Though some facets of the medical field recognize what the DSM-V calls “substance use disorder” as a legitimate disease, it still seems to be a hard pill (no pun intended) for insurance companies (and let’s face it, lots of other people) to swallow. Why is that?

Comparing Apples to Addicts

For starters, unlike someone with a drinking problem, a person with the aforementioned heart condition doesn’t put innocent people in danger when they get behind the wheel of a car. These same people don’t tend to lose their jobs, devastate their families or rob liquor stores to pay for butter, cheese, red meat and other things that clog their arteries. As much as the world may want to sympathize with addicts in the way they do other sick people, I can understand why it’s challenging. While a person with a pacemaker may not be able to run a marathon, their condition doesn’t typically prevent them from being a functioning and contributing member of society. But a 24-year old junkie—once a good student on his way to Penn State before becoming addicted to Oxycontin—on his third, unsuccessful stint in rehab is much tougher to feel bad for.

When you look at the facts, it might seem discriminatory for insurance companies to deny addicts extended coverage, but creating a one-size-fits-all policy around this issue can’t be easy. I imagine it’s confusing when some addicts can stay clean after one 28-day program while some continue to relapse despite multiple rounds of treatment. Then, there are addicts who don’t seek professional help at all; finding their way into the rooms of 12-step, SMART Recovery or other support groups by their own volition and that is enough for them. If I weren’t an addict myself, it would be hard for me to believe that these variations are due to many factors: fear of the unknown (living sober), lack of understanding about the disease (how it works in your brain) or not having really hit a bottom (something a person can’t choose).

For Those Who Want It, Not All Who Need It

Which brings me to my next point; another reason it’s so much harder to hold addicts to the same standard as those suffering from other ailments is that recovery from addiction is 100% dependent on the afflicted’s willingness to recover. No matter how much treatment an addict gets, if that person isn’t ready to quit, it isn’t going to work. Regardless of how much destruction we have caused around us, we are only done when we are done. This is very difficult and frustrating for people to understand—ourselves often being the most baffled.

We can’t control what drugs a kid may be offered, nor should we underestimate the power of sophomoric naivety. But we need to do our best to make sure everyone has the most information about addiction possible at the ground level. Once certain decisions have been made (i.e. to experiment with drugs)—or a medication like Oxycontin has gotten it’s hooks in via an injury, a chronic pain disorder or post surgery medication—we need to make sure we can offer people what they need to recover, if that is what they want to do.

Fighting for Equality

While research has shown that 90 days or more of treatment yields the best results, many healthcare professionals are only recommending three to six weeks of inpatient treatment, combined with step-down programs like IOP and an outpatient programs. Some companies will pay for more inpatient treatment after incremental evaluations. Valerie Fiore, who says her son met the criteria for extended coverage but didn’t get it, is fighting for more of a level playing field. She wants the Affordable Care Act to ensure that all insurance providers cover a minimum of 90 days of residential treatment—and we hope she succeeds.

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About Author

Danielle Stewart is a Los Angeles-based writer and recovering comedian. She has written for Showtime, E!, and MTV, as well as print publications such as Us Weekly and Life & Style Magazine. She returned to school and is currently working her way towards a master’s degree in Marriage and Family Therapy. She loves coffee, Law & Order SVU, and her emotional support dog, Benson.