Pubdate: Sun, 06 Apr 2014
Source: Cumberland Times-News (MD)
Copyright: 2014 Cumberland Times-News
Contact:  http://www.times-news.com/
Details: http://www.mapinc.org/media/1365
Author: Meghan Barr, Associated Press
Note: Part 2 of 3

HEROIN ADDICTS FACE BARRIERS TO TREATMENT

In Many Cases, Insurance Won't Cover Rehab Costs

[Cumberland] EDITOR'S NOTE - The death of actor Philip Seymour Hoffman
underscored a troubling development: Heroin, long a scourge of the
back alleys of American life, has spread across the country. Second of
a three-part series.

NEW YORK - As the ranks of heroin users rise, increasing numbers of
addicts are looking for help but are failing to find it - because
there are no beds in packed facilities, treatment is hugely expensive
and insurance companies won't pay for inpatient rehab.

Some users overcome their addictions in spite of the obstacles. But
many, like Salvatore Marchese, struggle and fail.

In the course of Marchese's five-year battle with heroin, the
Blackwood, N.J., man was repeatedly denied admission to treatment
facilities, often because his insurance company wouldn't cover the
cost. Then one night in June 2010, a strung-out Marchese went to the
emergency room seeking help. The doctors shook their heads: Heroin
withdrawal is not life-threatening, they said, and we can't admit you.
They gave him an IV flush, and sent him home.

Marchese, then 26, and his sister called multiple inpatient clinics
only to be told: We have no beds. Eventually, Marchese found space at
a facility but was released 17 days later when his public funding ran
out. Less than three months later, Marchese was found dead of an
overdose in his mother's car.

"Heroin is life-threatening," said his mother, Patty DiRenzo. "We're
losing kids every day from it."

Of the 23.1 million Americans who needed treatment for drugs or
alcohol in 2012, only 2.5 million people received aid at a specialty
facility, according to the federal Substance Abuse and Mental Health
Services Administration. Heroin addicts are a small slice of overall
drug users, but their numbers nearly doubled from 2007 to 2012, to
669,000. The number treated for heroin also increased, from 277,000 to
450,000.

At issue is whether these addicts are getting the treatment they need
to successfully beat their habits. Advocates say they are not, partly
because the insurance industry has not come to grips with the dangers
of heroin withdrawal and its aftermath.

It is true that, unlike withdrawal from dependencies on alcohol or
benzodiazepines like Xanax, heroin withdrawal does not kill. But it is
so horrible - users feel like their bones are breaking and fluids leak
from every orifice - that many are drawn back to the drug, with fatal
consequences.

Even if addicts survive withdrawal, they often relapse if they fail to
make it into treatment. That's when many overdoses happen, because
they try to use as much heroin as they did before, and their newly
drug-free bodies can't handle it.

Because withdrawal is not directly deadly, most insurance companies
won't pay for inpatient rehab, said Anthony Rizzuto, a provider
relations representative at Seafield Center, a clinic on Long Island.
They either claim that the addict does not meet the "criteria for
medical necessity" - that inpatient care would be an inappropriate
treatment - or require that the user first try outpatient rehab.

"Ninety-nine-point-nine percent of the time, we hear 'denied,"'
Rizzuto said. "And then we go to an appeal process. And we get denied
again."

Susan Pisano, a spokeswoman for America's Health Insurance Plans, the
trade association that represents the health insurance industry,
defended the industry's practices. "Health insurers rely on
evidence-based standards of care that look at: what is the right level
of coverage, the right site of coverage, the right combination of
treatments," she said.

There is debate over the best way to get clean, but most addiction
experts agree that inpatient care is often essential for full-blown
addicts. While most insurance policies allow coverage of up to 30
days, nobody gets all 30, said Tom McLellan, CEO of the nonprofit
Treatment Re-search Institute in Philadelphia who served as deputy
drug czar under President Barack Obama. The average duration is 11 to
14 days.

"It's not enough time. And what do you do?" McClellan said. "If the
treatment program calls you up and says, 'Your loved one is
half-treated, we'd like to keep him for another two weeks,' you take
out a mortgage on your house and you cover it."
- ---
MAP posted-by: Jo-D