Discrimination Through Denial of Coverage
Health insurance is probably going to be one of the great debates of this period in American history. There is already plenty of contention about how to properly provide coverage for those who need it. Some claim the changes made in the last decade have gone too far. Others argue it has not gone nearly far enough. Healthcare reform is a hot button issue in our world today. Needless to say, a big part of this conversation has to do with parity coverage for mental health. Now a new landmark court ruling is going to make a monumental difference for mental health and addiction treatment insurance coverage.
Simply put, the largest behavioral health care company in America has been denying coverage to some of its most vulnerable members to save money. And now, a federal court decision may put more of a spotlight on insurance companies.
Wit v. United Behavioral Health
The case was brought in front of a federal court in Northern California against United Behavioral Health (UBH). UBH is a company that manages behavioral health services for UnitedHealthcare and other health insurers. The court found that UBH denied claims of tens of thousands of people seeking mental health and substance use disorder treatment. The company was using defective medical review criteria in order to reject claims.
In Wit v. UBH, over 50,000 individuals were reportedly denied coverage based on the flawed review criteria. 11 plaintiffs sued UBH on the behalf of these victims. One victim, in particular, is Natasha Wit. Natasha had been seeking treatment for several chronic conditions, including:
Wit was repeatedly denied coverage for her treatment, despite the fact she did have healthcare benefits that should have offered coverage. Her family ended up paying out nearly $30,000 for treatment. And they are just one of the thousands of families to face the same discrimination.
Looking at the Marks Against UBH
According to recent reports, United Behavioral Health has been failing its members in more ways than one.
Federal courts determined that UBH developed internal guidelines that were “unreasonable and an abuse of discretion” and “infected” by financial incentives designed to restrict access to care for those who should qualify for coverage. Essentially, UBH was manipulating internal guidelines to avoid providing coverage that members had every right to under the law.
For many of those struggling with substance use disorder, defective criteria for coverage can equate to a death sentence. When looking over the requirements set by UBH, it is no wonder why the courts say they are illegitimate.
Firstly, their medical-necessity criteria fail to provide coverage to those chronic and comorbid conditions. Generally accepted standards of care state these conditions should be effectively treated, even when those conditions:
- Respond slowly to treatment
- Require extended or intensive levels of care
However, UBH set guidelines that only approve coverage for what they labeled “acute” episodes or crises. For example, only individuals who were actively suicidal or suffering from severe withdrawal could be considered for coverage.
In other words, for someone who struggled with substance use disorder or mental illness, you had to be knocking on death’s door to get a chance at treatment. The court found that these guidelines were not acceptable.
Furthermore, UBH fails to use national evidence-based guidelines for covering different levels of care for mental health and substance abuse treatment, such as:
These are guidelines that have been developed by clinical specialty nonprofit organizations.
Additionally, UBH’s guidelines improperly required reducing the level of care, even if the providers who were treating them recommended maintaining a higher level of care. So patients would be removed from more intensive residential treatment programs and pushing into some form of outpatient therapy, even if the specialists argued that they were not ready.
This is a big deal. Most recovery advocates and healthcare providers agree that insurance companies should not be the ones telling treatment providers how to care for their patients.
State Mandated Guidelines
Furthermore, some states have mandated specific guidelines for evaluating the medical necessity for behavioral health services. UBH was also found to have violated these requirements for reviewing substance use disorder claims as well.
The case against United Behavioral Health was filed under the Employee Retirement Income Security Act of 1974 (ERISA). This is a federal mandate that governs group health insurance policies through private employers. More specifically, ERISA requires insurance plan administrators to function in a fiduciary capacity when overseeing employee benefit plans. This includes coverage for mental health and substance use disorder treatment.
In Wit v. UBH, the court determined that UBH was in breach of its fiduciary duties by developing and employing faulty medical necessity criteria for behavioral health services. Therefore, the court alleges that UBH is in violation of its obligations under this federal law.
What Does this Mean for Addiction Treatment Insurance Coverage?
This case is exposing insurers for refusing care to people at serious risk of death by overdose or suicide. It is important to remember that UBH is not the only insurance provider trying to find ways around federal and state coverage guidelines. Given the nature of these violations, advocates believe that regulators should immediately start examining the market conduct of all healthcare plans across the country.
Judge Joseph C. Spero in Wit v. UBH also points out that the company was circumventing the Mental Health Parity and Addiction Equity Act of 2008, also known as the Federal Parity Law.
Parity law actually requires insurers to cover illnesses of the brain, such as depression or addiction, the same as illnesses of the body, such as diabetes or cancer. In his ruling on Wit v. United Behavioral Health, Judge Spero highlights an abundance of evidence that guidelines created by the UBH were designed to diminish the impact of the 2008 Parity Act in order to keep benefit costs down. In other words, it is clear that the company was actively trying to work around federal law in order to avoid providing coverage to people with mental illnesses and addictions.
For those in the mental health and addiction communities, this brings new awareness to the discriminatory practices of treating mental health conditions differently than physical conditions. The new hope is that insurance providers will understand the consequences of discrimination against those who need help. With so much going on in healthcare, the Federal Parity Law must be protected.
Far too many people suffering from mental health and substance use disorders never get the help that they need. The last thing we need in a country devastated by an opioid crisis and rising overdose death rates is to create more roadblocks to treatment resources.
Palm Healthcare Company believes that if our country is ever going to overcome the damage of the opioid epidemic, we have to offer more comprehensive treatment options to those who still suffer. Insurance companies should not be keeping people from the care they deserve. Prevention is important, but we also believe in taking care of those who are already in the grips of substance use disorder by offering compassionate and effective care. If you or someone you love is struggling, please call toll-free now. We want to help.
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(This content is being used for illustrative purposes only; any person depicted in the content is a model)
By: Thomas G. Beley, PhD, LCSW
There is a German fable that states that relationships are like two porcupines trying to keep warm in the dead of winter. Move in too close, or too quickly, in the anticipation of feeling the warmth, chances are the porcupines are going to experience some discomfort and pain from their respective ill-positioned quills. Yet, being afraid of getting too close to each other, the porcupines are likely to run the risk of dying from the winter cold.
As individuals, our relationships are not too different than the porcupines. Whether it is with family, friends, co-workers or strangers, we are constantly in a natural process of trying to determine just how close we need to be with someone while at the same time not sacrificing our own individual beliefs, values, or needs. It is the negotiation of these two natural forces of individuality and togetherness that determines the success of any relationship. Too much of either or an imbalance can have unsettling effects.
It is important to understand that individuals are subject to an inherent process of trying to reach a successful balance between these two natural forces. Research has shown that this is a process rooted in nature and all living organisms. Being a part of all life means we have the desire to be our own person yet at the same time desire the safety and security of the group.
Finding Balanced Relationships
In humans, this process happens both consciously and unconsciously. We seek out relationships that will give us both the opportunity to pursue our own individual needs while at the same time involve ourselves in a relationship that is nurturing and comforting. Our behavior, whether good, bad, or indifferent, is often influenced by these forces of nature of trying to find that right balance between one’s need for individuality and togetherness. The successful balance of these two life forces is what brings us a sense of well being and contentment. It is our ability to maintain this delicate balance between individuality and togetherness that determines the quality of any given relationship.
It is also important to note, here, that the quest for individuality or togetherness is not to say that one is more important than the other. They are both extremely critical. However, it is how a person balances these two forces within their life and the relationship systems in place that makes the difference between staying calm and collected and being in a state of turmoil and conflict.
Relationship conflicts often occur when there is an imbalance in these two natural forces. Imbalances can occur both within the individual and within the relationship system itself. A common scenario that often develops is when one person within the relationship system desires more individuality and the other person in the relationship system desires more togetherness and closeness. As is often the case, one person begins to feel overwhelmed in the relationship while the other person may feel neglected. Typically, the person desiring more individuality is running away from the relationship system while the person seeking more closeness is chasing the relationship system.
The Dance of Conflict
This “dance” can occur in a variety of ways. One such way is when an individual requires an excessive amount of one or the other. Too much of an individuality influence may make it difficult for that person to make a meaningful connection with others, particularly those who desire more closeness and togetherness. In that desire to achieve a sense of individuality, a person can easily cut him or herself off from others. Along the same lines, a person with a high degree of individuality may find others having a difficult time making a meaningful connection with him or her. The same holds true for the person needing a great deal of togetherness. The desire to achieve closeness can result in the person becoming excessively dependent on others or not maximizing their own individual potential.
Another common scenario that is when one person desires individuality and the other person is requiring a sense of togetherness. A person who requires a sense of individuality will likely create a conflict in the relationship system of the person who has the desire to achieve more togetherness. The same dilemma holds true if two people have inordinate amounts of the same needs. Two people desiring a great deal of individuality will likely experience the cold of winter. Two people desiring a great deal of togetherness will likely feel the quills of another person. When there is an imbalance of these needs, anxiety occurs and the potential for conflict exists.
Find What Matters
It is important to emphasize that there is no magic formula that constitutes what is the right amount of togetherness or individuality within a relationship system. What truly matters is how a person manages their respective needs and the awareness of the needs of the other within the relationship system.
Doctor Thomas G. Beley, Ph.D., LCSW is the Executive Director of Palm Healthcare Company. For over 25 years, Doctor Beley has worked in the field of substance use disorder and mental health disorders. Through the years of helping people who struggle with drugs, alcohol and mental health issues, Doctor Beley has proven to be an expert clinician and an innovative and compassionate leader in the treatment industry. Palm Healthcare Company is grateful to have an executive team with experience and incredible commitment to helping others. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Bullying is a concept we are all familiar with. We each experience bullying at some point in life, to one extent or another. Even those who become bullies have often been bullied at some point. Technology and social media have created a whole new breed of cyberbullying, and too many people don’t take bullying very seriously. When you look at bullying statistics, the impact can lead to other real issues, including substance abuse and addiction.
To be a Bully
Firstly, let us look at what it is to be a bully. The title is typically described as the use of superior strength or influence to intimidate, typically to force someone to do what one wants. The site stopbullying.gov defines it as unwanted, aggressive behavior that involves real or perceived power imbalance. This behavior is repeated or has the potential to be repeated over time. It also concludes that both those who are bullied and those who bully often have serious, lasting problems.
Bullying statistics show three categories of behavior:
1. Verbal Bullying
This type of bullying is about the things we say or write. Verbal bullying includes:
- Inappropriate sexual comments
2. Social Bullying
This involves hurting someone’s reputation or relationships. Social bullying includes:
- Leaving someone out on purpose
- Telling other children not to be friends with someone
- Spreading rumors about someone
- Embarrassing someone in public
3. Physical Bullying
Physical Bullying involves hurting a person’s body or possessions. It includes:
- Taking or breaking someone’s things
- Making mean or rude hand gestures
Sadly, the prevalence of bullying often convinces people that it is just a rite of passage. A lot of people don’t take the issue seriously enough. Adults often justify the behavior as a sign of immaturity, without realizing the genuine harm that comes from it.
The Impact of Bullying
Being bullied can lead to many other adversities in life, including physical violence and mental health problems.
Because both behaviors are so common, it is difficult to correlate bullying and substance use. When looking at addiction and bullying statistics, according to 2016 Monitoring the Future survey:
- More than 17% of children have tried drugs by 8th grade
- Almost 50% have used illicit drugs by senior year in high school
- Childhood alcohol use rates are even higher
According to the CDC’s 2015 Youth Risk Behavior Survey:
- 20% of American high schoolers have been bullied in school in the past year
- More than 15% have been bullied electronically in the past year
Bullying can erode a child’s self-esteem. It can deplete their confidence, even for those who parents may believe are confident enough to endure a bully. Over time, they learn to question their self-worth. If a bully targets a specific attribute of the individual, they may begin to obsess over it.Some bullying statistics show that those who have been bullied are six times more likely to be diagnosed with mental health issues. It is extremely common for victims of bullying to develop progressive behavioral disorders such as:
Over time, they may turn to alcohol or drugs to ease the pain. Also, the desire to fit in and feel accepted can lead a child using drugs to connect with people. Several studies show the risk factors for psychological health problems, substance abuse, and bullying statistics often overlap.
Similarity in Symptoms
When we look closer at bullying statistics and at the warning signs of substance abuse, we find that the symptoms are extremely similar.
Common Symptoms of Bullying
- Changes in sleep patterns
- Changes in eating habits
- Eating disorders
- Poor performance in school or work
- Loss of interest in activities
- Alcohol or drug use
Common Symptoms of Substance Use Disorder
- Mood swings
- Poor performance in school or work
- Withdrawal from social activities
- Health problems
Looking at some of the more general warning signs we can see how many are present concerning both issues.
Substances and Bullying Statistics
Ultimately, drugs can become a crutch for numbing the emotional pain of being bullied. While it is harder to predict whether being the victim of bullying will lead to substance abuse, with bullies there is also a very real risk of developing issues with drug use and addiction.
Bullying statistics often show that bullies themselves typically suffer from a variety of emotional and behavioral challenges. Sometimes a child lives in a home with domestic violence, and so they become aggressive with their peers to expel their frustration. Yet, they may still use drugs or alcohol to escape the painful life at home. Even the act of bullying itself is typically an indication of diminished self-worth, and just like with the victims, that lack of self-worth can lead them to use drugs.
Some even believe bullying could be comparable to an addiction itself. Some psychologists compare bullying to other ‘process addictions’ like gambling, overworking or shopping. While we do not recognize bullying as an addiction, many believe the comparison could be helpful to address the issue.
Compassion and Care
Whether or not someone is a victim or bullying, or has been a bully themselves, we all deserve respect and compassion. When it comes to providing care for those who struggle with substance use disorder, it should always be a priority to help people develop healthy coping skills, while gaining self-worth. As people struggle to deal with emotional and behavioral challenges, there should be resources there to help guide them toward personal development. Not just getting off of substances, but also to empower them as an individual.
One issue we have with facing bullying head-on is that people typically think of a “bully” as someone inherently bad. However, life is not so simple. A child who bullies isn’t a bad child, they are just interacting with their world in an unhealthy and aggressive way. They still deserve understanding and support.
We commonly see the same stigma with people struggling with addiction. Too often they are labeled as “bad” people, but the truth is that they are just dealing with things in a self-destructive and unhealthy way. Dealing with substance use disorder and with bullying means meeting it with love and care, not judgment and punishment.
Perhaps if focus more on supporting people, we have a better chance of changing addiction and bullying statistics for the betterment of everyone.
Palm Healthcare Company believes in the importance of compassionate and comprehensive care for those struggling with substance abuse and addiction. Providing a safe medical detox, a personalized recovery program and an innovative approach to holistic health, our mission is to help people transform into the person they want to be. If you or someone you love is struggling, please call toll-free now.
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This past week the Center for Disease Control and Prevention (CDC) issued a statement warning people to stay away from Kratom while health officials investigate the possible connection between the plant and a nationwide outbreak of salmonella.
Multi-State Salmonella Outbreak
So far 11 people have been hospitalized as a result of this recent salmonella outbreak, and the CDC believes that kratom may actually be responsible for the recent chain of illnesses.
Since October, 28 cases of salmonella were recorded in 20 states, including:
- New York
- North Dakota
- North Carolina
- South Carolina
So far there have been no deaths, but nearly a dozen people have ended up needing to be hospitalized.
Most people infected with salmonella develop symptoms with 12 to 72 hours of exposure to the bacteria. Some symptoms include:
- Abdominal cramps
According to the advisory released by the CDC, 11 people affected by the salmonella outbreak were interviewed. Out of those 11 people, 8 of them admit to consuming kratom. That is a 73% connection so far. These individuals had taken the plant via:
Therefore, at this time kratom is the primary suspect in the CDC’s investigation. The advisory states:
“Epidemiologic evidence indicates that kratom is a likely source of this multistate outbreak. At this time, CDC recommends that people not consume kratom in any form because it could be contaminated with salmonella.”
But it wasn’t just the CDC. The very next day the Food and Drug Administration (FDA) issued a statement announcing the recall of “kratom-containing dietary supplements” manufactured and distributed by Divinity Products Distribution of Grain Valley, Missouri. This manufacturer is not yet determined to be the cause of the outbreak, but the company voluntarily recalled its kratom products and promised to stop selling them.
CDC, FDA, and DEA vs Kratom
At this time the FDA is encouraging other kratom companies to follow the Missouri company’s lead. They urge other manufacturers to- “take swift action to remove these products from circulation to protect the public.” The FDA Commissioner Scott Gottlieb states,
“To protect the public health, we’ll continue to affirm the risks associated with kratom, warn consumers against its use and take aggressive enforcement action against kratom-containing products.”
Proponents of kratom do argue that the FDA has been working especially hard in the last few years to prove that kratom is a threat to public health. In early February the FDA claimed it found evidence that certain compounds in kratom interact with the body’s opioid receptors. This led the agency to conclude that “compounds in kratom make it so it isn’t just a plant—it’s an opioid.” In America, the use of this plant is actually already banned in 6 states. The DEA also considers it a drug of concern. Even though back in October of 2016 the DEA announced they would not be banning kratom and giving it a schedule 1 label.
However, the American Kratom Association and other kratom advocates are willing to keep pushing back against the FDA. Many kratom users claim it is useful for helping addicts self-medicate to lessen the withdrawals when getting off heroin and other opioids. Yet, there is not enough research out there yet to fully endorse this claim, and a lot more would have to be done to legitimize it.
Either way, because kratom products are very loosely regulated by the FDA, it isn’t hard to understand why they are asking people to stop using the plant until they have been able to identify the source of the bacteria.
So far, no specific brands or suppliers have been singled out, but health officials are still urging people to be safe and avoid kratom products.
Many may still debate the benefits and the risks with kratom. Either way, both sides agree that more research is needed. Whether or not the drug should be banned is still a question that has yet to be answered. The one thing we do know is that kratom is a mind-altering substance, so using it might be detrimental to some people trying to recover from addiction. Right now, it doesn’t seem safe for anyone, anyway. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now. We want to help.
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Most people who own a television have probably seen Gabriel Byrne at work, but just in case you haven’t, go watch The Usual Suspects. In fact, if you haven’t seen that movie in a few months, go watch it again. Totally worth it. Or you may recognize him from one of many other roles, including:
- Stigmata (movie)
- End of Days (movie)
- Vikings (series)
- Marco Polo (series)
Gabriel Byrne is Irish born actor who has also a grown into a successful film director, film producer, writer, cultural ambassador and audiobook narrator. Since the beginning of his acting career in 1979, he has struck the silver screen and small screen a multitude of times with powerful and intense performances.
He won a Golden Globe Award back in the HBO drama In Treatment, which aired from 2008 to 2011. That role also earned him nominations for various other awards.
But just last week the 67-year-old actor accepted another awesome honor- a lifetime achievement award from the Irish Film and Television Academy (IFTA). The following night, he took the time to reflect on what he considers one of his biggest victories– his 21 years of recovery from alcohol.
Gabriel Byrne on Drinking and Recovery
During an interview on Ireland’s The Late Late Show,
“I think like a lot of people, I drank to escape from myself and to escape from the pressure that I felt around me. But I knew that I could never handle it, I was absolutely allergic to it. It was not a good thing for me to do.”
“With this lifetime achievement thing, it’s not about the work, it’s of a life and one of the biggest victories to me in my life was that personal one of stopping that and saying I’m not going to be that person anymore.”
But Gabriel Byrne didn’t stop with discussing his own issues with alcohol. He also spoke about his feeling toward the culture in Ireland which endorses drinking.
“That kind of thing became to me kind of frightening because my drinking was spiraling into a place where I couldn’t remember what I did.”
“One day I woke up and said, ‘If I don’t stop this, I am going to die.’”
Byrne admits that it took him a long time to be brave enough to admit he had a problem and needed help. His agent of 30 years, Teri Hayden, was instrumental in getting him the help he needed. She was the first person he went to for help. Describing walking into a room full of strangers looking for help with his drinking Gabriel Byrne says,
“It was the most difficult thing I’ve ever done.”
After over two decades in sobriety, it seems Gabriel Byrne seems committed to his work as both an actor, an activist and an advocate for recovery. He also acknowledges that a lot has changed since he left Ireland for the United States, adding that he is actually encouraged by how the culture is shifting. He is happy to see now that it is no longer strange in Ireland for people to recognize their drinking problems and ask for help.
We love sharing celebrity recovery stories because they remind us that anyone can be impacted by addiction. Actors, artists and musicians often experience the same devastation that can be caused when drugs take hold of their lives, and their stories of overcoming fear and stigma to get help can be inspiring. Everyone might not have access to the same resources as celebrities, but there are still effective treatment options. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398