Substance Abuse Treatment Centers Report Problems With Insurance Coverage

Substance abuse treatment providers say patients are having problems getting their care covered, even though such treatment is now considered an essential health benefit under the Affordable Care Act.

The Mental Health Parity and Addiction Equity Act requires larger employer-based insurance plans to cover psychiatric illnesses and substance use disorders in the same way they do illnesses such as cancer and multiple sclerosis. The law was passed in 2008 and went into effect for most plans in 2010.

USA Today reports as of January 1, the Affordable Care Act added mental health and substance abuse treatment to its list of essential health benefits that must be covered in individual and small business health insurance plans. Coverage of this treatment cannot be any more restrictive than medical coverage, the article notes.

“Many providers … report less days and more difficulty with reimbursement since the final rules were established,” Michael Walsh, CEO of the National Association of Addiction Treatment Professionals (NAATP), told the newspaper. He said many providers and insurers disagree “as to what the practical implementation of the rules should be and what should be covered.”

A survey by the NAATP shows 63 percent of denials for substance abuse treatment coverage since last July have involved disagreement over what qualifies as a medical necessity. “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.

Ben Brafman, CEO of Destination Hope treatment center in Fort Lauderdale, Florida, said that since the new essential benefits rule has been in effect, insurance companies have become more strict about what they will allow. In many cases where his center says patients need 30 days of in-patient treatment, insurance companies are only approving up to five days.