🔒Insurance ‘parity’ for addiction treatment inadequate

Among the countless substance abuse patients I've worked with during my 17 years inside detox units, pain clinics and mental health centers, a patient whose story sticks out in my mind is someone I'll call Sally.

I was called to triage to evaluate Sally, who was addicted to heroin and homeless after leaving an abusive boyfriend. Staff said Sally was “combative and difficult” after being told she could not be admitted to detox until her withdrawal was severe enough, according to her insurance policy.

It takes a huge commitment to say “I am ready to make the change,” stop your life, step into a treatment center, and be ready to embrace the change before you.

To be told you don't meet the criteria to be in detox and getting angry at staff after 26 hours in triage is an understandable and common response for a patient on the brink of this change.

I explained this to Sally and we commiserated about our frustrations with the system. She vomited and approached the withdrawal score we needed to admit her.

Sally had no job or access to transportation nor mental health medications. She needed “total case management” on day one. Before she was even awake in detox, her clinician had already started looking for a female bed in a treatment facility for aftercare.

We had four days left before insurance would no longer fund Sally's stay. With such a short amount of time, and a dearth of rehab beds in the state, we couldn't find her an accommodation.

Her struggle is not uncommon for the addicted. Those seeking detox are often required to wait hours or even days until they are sick enough to meet medical necessity criteria.

This is emblematic of the disrespect, degradation, humiliation and loss of human spirit that the addicted person endures in both their own self perception and from the community around them.

Medical providers who treat addiction also face an uphill battle, as they often have only days to detox a patient, help schedule outpatient appointments, meet with family members, and sometimes, if possible, locate housing or employment.

It's exhaustive work, whether it's in a detox unit or an outpatient pain clinic. Patients are often in pain, angry and suffering psychiatric challenges to boot. If a pain clinic's medical staff refuses to prescribe the painkillers, addicted patients threaten to purchase the drugs illegally. We know very clearly that if we do not engage them adequately, they may leave, overdose and die.

Though federal law requires “parity” in the treatment of addiction and mental health, in reality our healthcare system offers better care for chronic conditions like diabetes, asthma and heart disease.

No disease carries the social stigma, legal consequences, or invites moral judgment like addiction, even though it is based in biology like any other illness.

We get distracted by the behaviors surrounding addiction and we often lose sight of the lost, sad and broken human being in need of more treatment and less legal trouble.

While we understand addiction is more complicated to manage than other chronic conditions, we continue to fail to hold payer sources accountable to parity laws.

Several bills that did not pass the legislature this year would have helped us in our fight against the opioid epidemic, including legislation that would have mandated longer detox and treatment insurance coverage.

Our citizens will not recover from this disease, which happens to carry far-reaching social, legal, and economic consequences, until we commit to accessible health care for folks like Sally.

Danielle Morgan is a family psychiatric nurse practitioner in private practice in New Haven and Guilford and a member of the medical staff at New Solutions Pain Management Clinic in Milford.