Heroin addiction is one of the most difficult forms of substance abuse to quit and addicts need extensive treatment to experience a successful recovery.
Unfortunately, many heroin addicts seeking help for their problem are finding it hard to get approval for their treatment from insurance companies.
With heroin use escalating across the U.S., the demand for treatment has been increasing beyond the supply making it even more difficult for heroin addicts to get help from rehabilitation services. Insurance companies are placing strict restraints on treatment to save money, while heroin addicts must sometimes wait weeks to enter crowded treatment centers. The difficulty of obtaining treatment due to insurance problems and high demand often causes addicts to give up on seeking help.
Insurance Companies And Inpatient Treatment
The most effective kind of treatment for people with a severe heroin addiction is access to an inpatient rehab facility. These kinds of facilities offer around the clock care, medication, counseling and coping skills that help patients develop the ability to stay sober after they leave the treatment program.
Even for people with insurance coverage however, getting approval for these types of facilities is often a struggle. Insurance companies often decline to pay for the expenses of an inpatient treatment center unless the addict fails to stay clean in a less expensive outpatient program.
Even when doctors recommend specific kinds of treatment for patients struggling with heroin addiction, insurance companies choose only to approve the less expensive approach. Outpatient treatment for a person suffering from heroin addiction can be much more difficult because patients are unable to live in the facility or receive the same level of assistance.
Coverage Criteria For Approval Or Denial
For heroin addicts, insurance companies place certain restrictions on their ability to receive coverage for inpatient treatment. Even if their doctor specifically says that they need help from an inpatient facility, the patient's insurance will only look at certain factors to approve them.The insurance wants to see evidence that the addict has already tried outpatient programs and failed to become sober, that they have little outside support or they have a health condition that makes treatment a medical necessity.
If patients do not meet the criteria, then they will not be approved to receive coverage for inpatient treatment. Advocates for insurance companies assert that outpatient treatment can be an effective option and inpatient is only necessary when people fail to respond to this type recovery method. Many addiction specialists, however, believe from their experiences working with people fighting addiction that inpatient works better.
There have been many cases of heroin addicts dying of overdose after being denied coverage for inpatient services. Families of heroin addicts and overdose victims are lobbying for medical professionals to have decision-making authority for addiction treatment rather than insurance companies directing the outcome.
Problems Finding Treatment
Another issue that addicts face is the ability to get a spot in the high demand inpatient treatment centers. Heroin abusers often have to wait weeks to be admitted into a treatment center because the facilities are full.
This can be dangerous for addicts who are involved in a serious heroin abuse problem and need help immediately. The number of deaths related to heroin overdose has skyrocketed in the past few years throughout many areas of the U.S.
Even after experiencing an overdose and being placed in a treatment center for emergency reasons, many addicts are still denied coverage by their insurance companies which only approve outpatient centers for treatment.
Families of heroin addicts assert that insurance companies should approve the advice of medical professionals who have years of training and are making a diagnosis that would provide the best outcome. Insurance coverage should then be based on medical diagnosis rather than seeking the least expensive option.