Tag Archives: insurance

For many heroin addicts, treatment barriers remain

heroinspoonThe rise in heroin addiction across the nation, fueled by the prescription drug addiction epidemic, means that increasing numbers of people are in need of inpatient treatment services — but many who need help are contending with a shortage of services and constraints placed on care by insurance companies, according to this article.

Unlike withdrawal from dependencies on alcohol or benzodiazepines, heroin withdrawal isn’t life-threatening – but it is so horrific that many addicts are drawn back to the drug and overdose, the article notes. Because withdrawal is not directly deadly, most insurance companies won’t pay for inpatient rehab, either claiming that the addict does not meet the “criteria for medical necessity” — that inpatient care would be an inappropriate treatment — or requiring that the user first try outpatient rehab, the article says.

Of the 23.1 million Americans who needed treatment for drugs or alcohol in 2012, only 2.5 million people received care at a specialty facility, the article says, citing data from the Substance Abuse and Mental Health Services Administration.

The number of people reporting heroin use in the previous year increased between 2007 and 2012, from 373,000 to 669,000, while nearly 80 percent of people who had used heroin in 2011 had also previously abused prescription painkillers classified as opioids.

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Heroin addicts facing treatment barriers

drug moneyThe rise in heroin addiction across the nation, fueled by the prescription drug addiction epidemic, has caused an uptick in the number of people in need of inpatient treatment services — but many who need help are contending with a shortage of services and constraints placed on care by insurance companies. The increase in demand for treatment has left many addicts to wait weeks in some cases for care because of denial from their insurance companies, according to this article. Before insurance companies agree to cover inpatient services they want evidence that an addict has tried one or more outpatient programs, has little or no outside support network, and has a health condition that makes treatment a medical necessity, the article says.

Previously, a typical inpatient program lasted a month and the average detox program ran seven to 10 days; these days, as a result of insurance companies scaling back their coverage and increasing their deductibles, inpatient services generally run 10 days and detoxes three to five days — and most insurers will only pay for up to 10 days, the article says.

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