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Addicts: How to avoid insurance scams

There was a time – about 8 years ago – when insurance companies could refuse to cover drug and alcohol treatment. The ones that did often had limits on the number of times an addict could go. Some polices would pay for one shot at treatment. Others paid for two or three. If you couldn’t get clean and sober after three rounds of treatment – you’re on your own.Recovery signpost

Then Congress passed the the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Several years late came the Affordable Care Act – Obamacare. Under these two laws insurance companies were required to provide the same coverage for mental health as physical health.

In other words, there could be no limits on the number of times addicts could go to treatment unless similar limits were placed on other illnesses. So, insurance companies couldn’t limit the number of times an addict went to rehab any more than they could limit the number of rounds of chemo a cancer patient needs.

This was huge milestone for mental health care in the United States and insurance companies did not like it. Countless addicts were finally able to get the treatment they needed. But for countless others – especially young addicts in south Florida on their parents’ insurance – it meant an extended vacation.

The more you relapse, the longer you get to stay. Palm trees. Beaches. And unlimited supply of cheap heroin and other young addicts. I mean, what 23-year-old newly clean addict would want to go back to New Jersey in January when you can relapse and be back in treatment for another 3 – 6 months?

If you’re not a 23-year-old heroin addict, this probably sounds crazy, right? But it happens all the time. But what happens when the addict turns 26 and mommy and daddy’s insurance policy doesn’t cover them anymore?

Don’t worry. Other millennials who work at intensive inpatient and outpatient programs – some with just a year or so clean themselves – will help you get insurance. In fact, some of these kids actually know more about the mental health coverage of specific insurance plans than most insurance agents.

Until last year, everyone in south Florida knew that Cigna’s 792 policy available on Florida’s marketplace had the best coverage. Some unscrupulous marketers and intensive outpatient treatment centers would even offer addicts from out-of-state a Florida address so they could sign up for Cigna’s 792 plan and attend their IOP. (It’s a felony to help someone lie about their residency to get an insurance policy, by the way.)

These young addicts fresh off the plane from Boston, New York, New Jersey or Philly, had no clue how to buy insurance on Florida’s marketplace. But there was no shortage of people willing to help – as long as they got a cut of the insurance money flowing in.

What happened when the addict couldn’t pay the premiums, deductibles or co-pays? No problem: “You sign a promissory note promising to pay us back and we’ll pay take care of those bills. We’ll even buy you a ticket to Florida!”

Do you think those promissory notes were paid off?

It got so bad that Cigna pulled out of Florida’s marketplace and is auditing claims and refusing to pay some treatment programs. Other insurance companies are also refusing to pay – especially for urine drug tests.

Today, in the south Florida – the nation’s drug treatment capital – drug addicts find themselves in the same situation they were before Obamacare and the mental health parity laws were passed. Unable to get the treatment they need because insurance companies won’t pay.

But this time, we have no one to blame but ourselves.

 

Addicts: How to avoid insurance scams

Christine Stapleton

Christine Stapleton has been a journalist for 35 years. She is now an investigative reporter for The Palm Beach Post. In 2006, began writing a blog for PsychCentral called Depression on My Mind. Her latest blog, Addiction Matters, draws on her 19 years of sobriety and her coverage of the drug treatment industry in South Florida.


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APA Reference
Stapleton, C. (2016). Addicts: How to avoid insurance scams. Psych Central. Retrieved on March 24, 2019, from https://blogs.psychcentral.com/addiction-matters/2016/07/addicts-how-to-avoid-insurance-scams/

 

Last updated: 19 Jul 2016
Last reviewed: By John M. Grohol, Psy.D. on 19 Jul 2016
Published on PsychCentral.com. All rights reserved.