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Tuesday, March 11, 2014

Substance Abuse Treatment Centers Reporting Insurance Roadblocks

The Affordable Care Act mandates that insurance companies cover mental health problems, but insurance companies are not making it easy for patients to get coverage. What’s more, the Mental Health Parity and Addiction Equity Act that went into effect for most plans in 2010 compels larger employer-based insurance plans to cover mental illness and addiction as they would any other health problem. Despite the reforms listed above, substance abuse treatment centers are reporting insurance roadblocks that are making it difficult for patients to get coverage.

As of January 1, 2014, mental health and substance abuse treatment was added to the list of essential health benefits that must be covered in individual and small business health insurance plans, according to USA Today


It is hard to imagine that, “many providers … report less days and more difficulty with reimbursement since the final rules were established,” says Michael Walsh, CEO of the National Association of Addiction Treatment Professionals (NAATP). Walsh pointed out in the article that insurers disagree “as to what the practical implementation of the rules should be and what should be covered.”

Since last July, 63 percent of denials for addiction treatment coverage have involved disagreement over what qualifies as a medical necessity, according a NAATP survey. “There’s a lot of confusion within the industry on how health care reform is going to be enforced,” said Nate Kasper, a Kansas treatment facility executive who heads the NAATP study.

Insurance companies should not have the ability to dictate how much treatment is required for a patient to get well. If a doctor orders the patient to receive inpatient treatment for 30 days and the insurance company says that they will only pay for 7 days, it stands to reason that the insurance company, not the doctor, is taking it upon themselves to determine what is necessary for the patient. One thing is certain, insurance companies are for-profit entities, not doctors; the government needs to remind them of that.

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