Insurance Fights Paying for Drug Rehab

Last year marked the 40th year since the “War on Drugs” was declared. Overall, most stories carried remarks by leaders who don’t believe that the war has been won. In fact, most say that the drug problem is far worse today than it was 40 years ago. It appears that making something illegal doesn’t stop it from occurring.

There were a number of stories about what to do instead of just hauling people off to prison where they can be tutored in the finer arts of criminal activity. There is a strong leaning towards providing care and assistance to those who are addicted to drugs. Some statistics say that with all the money that goes into police work and court staffing, medical and psychological help could be given. Drug Courts, in particular, have proven that requiring and assisting the addicts is a better road to travel.

But who is going to decide on which treatments are the best for each individual?
It was only a matter of time before that discussion reared its head. Should the courts decide? Should the doctors decide? Or should the health-insurance companies decide?

A story from the Associated Press on September 7, 2011 reported that the health-insurance industry has filed a lawsuit against our state regulators, counties and prosecutors. The HMO’s (Health maintenance organizations) believe that the decisions about the treatments for drug and/or alcohol addiction should be made by them.

It all comes back to “who’s going to pay the bill?”

State regulators have reported that there have been increased complaints about being denied services that doctors have ordered. Insurance companies vary as to what they will cover, but in general, they all want to be the ones that decide.

But how can a person in an office in another state have any idea what is needed or what is best for an individual who is struggling with addictions? Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania says, “The issue is who's making the decision and should it be someone who's looking at the patient.”

In 2010 the PA Insurance Department clarified the matter by saying that only the referral of a physical and/or psychologist was needed. The insurance industry decided to bring the lawsuit. The Commonwealth Court will not decide for several months.