Pubdate: Wed, 02 Aug 2006
Source: St. Paul Pioneer Press (MN)
Copyright: 2006 St. Paul Pioneer Press
Contact:  http://www.twincities.com/
Details: http://www.mapinc.org/media/379
Author: William Celis, Public Access Journalism
Note: William Celis teaches journalism at the University of Southern 
California's Annenberg School for Communication. He is a former 
reporter for The New York Times and The Wall Street
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

CHALLENGE ONE - DECIDING TO FIGHT ADDICTION

Challenge Two: Paying For It

Every month, the staff at Caron Treatment Facilities in Wernersville, 
Pa., field calls from nearly 2,500 people looking for help to pay for 
treatment to kick their addictions.

The call volume points out one of the larger dilemmas of addiction 
treatment. You've made the life-saving decision to go for help; now 
how do you pay for it?

With 30 days of treatment running anywhere from $14,000 to $30,000, 
the cost can seem insurmountable for someone already in a shaky 
position to deal with high finance, red tape and insurance companies.

"You're not out of luck, but you face a lot of challenges getting 
help," said Dr. Eric Goplerud, the director of Ensuring Solutions to 
Alcohol Problems, which reviews state insurance policies for the 
Department of Health Policy at George Washington University in Washington, D.C.

If you live in Connecticut, Delaware, Indiana, Kentucky, Minnesota, 
New Jersey, Vermont or Virginia, you're fortunate. Laws there require 
that insurers treat alcoholism as a chronic disease, offering 
coverage equal to that for diabetes or cancer.

But there are nearly as many states where you're virtually 
unprotected. In Arizona, Idaho, Iowa, Oklahoma and Wyoming, insurers 
aren't required to pay for treatment and recovery programs. There is 
little uniformity in the rest of the nation, but coverage is minimal.

For starters, co-payments for addiction treatment are severely 
curtailed. Under the strictest of policies, you're expected to pick 
up as many additional doctors' visits as necessary, and if you need 
the extended treatment recommended for a good chance at recovery, 
most carriers will pay for no more than a month at the top end. If 
you need help for the mental or emotional health issues often paired 
with addiction, your co-payments go even higher.

Uneducated views about the causes of substance abuse actually have 
resulted in steady erosion in coverage, Goplerud said. Insurance 
companies today pay roughly 25 percent of all claims related to 
alcohol and drug addiction treatment and recovery expenses, down from 
a third as recently as 1991. The balance is largely absorbed by 
public sources, like Medicaid, and the affluent, who can dip into 
their own pockets for customized treatment.

That leaves most low- and middle-income Americans struggling to pay 
for treatment, or going without.

Treatment and recovery providers are stepping into the void, offering 
help in determining how much coverage you're entitled to and where to 
find it. Some centers even provide financial assistance.

Caron Treatment Facilities, a nonprofit treatment and recovery 
provider, offers what it calls "scholarships" to help offset its 
fees, ranging from $23,000 for adults and $25,000 for clients 19 and 
under. The expense covers a 31-day treatment program and outpatient 
services. Riggs says 35 percent of Caron's clients currently receive 
some financial aid. Caron has covered up to half of a client's bill 
with money generated by fundraising events that include dinners and 
contributions from alumni - and even employees.

The application process is a lot like seeking a credit card. Caron 
reviews an applicant's income, debt and credit rating, since the 
balance of the bill will fall to the client.

In the workplace, corporate benefits officials still balk at paying 
for substance abuse-related expenses. Stubborn attitudes contribute 
to the discriminatory policies.

Last fall, Goplerud conducted four focus groups with corporate 
executives and benefits managers about the coverage offered for 
substance abuse treatment in company-sponsored health plans. While 
most of the participants said they were aware of the research linking 
biological factors to addiction, "You don't have to scratch too far 
below the surface for them to say they aren't sure they want to pay 
for 'bad behavior,"' Goplerud said.

A handful of companies have come up with enlightened benefits, 
policies and practices. Quad Graphics, a large, private commercial 
printing company in suburban Milwaukee that prints Newsweek magazine, 
offers employees with addictions 24-hour access to health care professionals.

Antiquated laws also play a role in limited financial support and 
access to treatment. Thirty-two states still enforce statutes - the 
Uniform Accident and Sickness Policy Provision Laws - enacted in 1947 
that allow insurance companies to refuse payment to hospital 
emergency rooms if an alcohol-or drug-related trauma brought you 
there. To get around the payment issue, doctors may not report the 
substance abuse, so those who need treatment don't get it.

Goplerud, whose center tracks, among other trends, the financial 
impact of alcohol addiction, calls these "bad laws." Four states and 
a number of leading medical and physician-led organizations agree; 
they've called for their repeals.
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MAP posted-by: Beth Wehrman