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.
CALL NOW 1-888-922-5398
8 months ago, Florida was home to 953 licensed drug treatment centers, and 207 were in Palm Beach County. As of April 1, there are now 185 in Palm Beach, with 771 in the whole state. This decrease is due to the crackdown on fraud by Palm Beach State Attorney’s Office, which has led to 45 arrests in the last year and a half. So far, those arrests have led to 16 convictions. For State Attorney Dave Aronberg there is no sign of slowing down.
Recently, Dave Aronberg spoke with Opioid Watch to talk about the work his office has been doing to try and strengthen the addiction treatment industry. Chief Assistant State Attorney Alan Johnson also sat down to talk about how Palm Beach County is fighting to protect those who are coming to Florida for help. Johnson heads the office’s Sober Homes Task Force.
Dave Aronberg VS Purdue Pharma
According to Aronberg, he got involved with opioid-related issues back in 2001, when he was an assistant attorney general. Aronberg says he was asked by his boss, Bob Butterworth, to investigate Purdue Pharma. This Big Pharma giant is the producer of OxyContin. This powerful prescription opioid has been credited with making a heavy contribution to the opioid crisis. Dave Aronberg was to examine the marketing practices of Purdue Pharma, and is quoted in the interview transcript stating:
“I believe we were one of the first in the country.”
Of course, now Purdue Pharma is one of many big name pharmaceutical companies being accused in lawsuits across America. In fact, Delray Beach, Florida recently filed its own case against the company.
When asked about what he found, Aronberg said that Purdue was marketing the product like it was Advil. Purdue has been repeatedly accused of pushing this product as if it was far less dangerous than it actually was. In 2002, Dave Aronberg was elected to state senate, and shortly afterward the case against Purdue was settled. In the edited interview transcript, Aronberg is quoted:
“Purdue also offered $2 million to the state to establish its first prescription drug monitoring program. I worked in the state senate to get the PDMP enacted into law. But some conservatives refused to go along. They thought it was Big Government. So Purdue’s $2 million went away, because the offer expired. We didn’t get the PDMP till 2011. By then the carnage was horrific.”
Furthermore, Opioid Watch notes that a Purdue spokesperson confirmed that the state failed to implement a PDMP by July 1, 2004, which was the expiration of the companies offer.
Dave Aronberg Goes to Congress
In December of 2017, Aronberg went in front of Congress to testify concerning fraud and abuse in the addiction treatment industry. In this meeting, they discussed various issues with shady facility operators in Florida and made suggestions on how the law could step in to change it and protect patients. The interview transcript quotes Aronberg:
“In recent years, we’ve had an influx of unscrupulous operators who enrich themselves by exploiting those in recovery. As a consequence, we’re attracting thousands of young people from throughout the country into fraudulent rehab centers. (We’re talking about some, not all. There are good rehab centers, too.)”
Again, Aronberg found himself at battle with shady marketing practices. While investigating the treatment industry, Aronberg’s office discovered illegal operations that not only manipulated insurance providers but put patients at extreme risk.
From patient brokering, where illicit actors would sell patients with insurance to the highest bidders, to illegal kickback schemes being run by sober homes to outpatient treatment programs. Chief Assistant State Attorney Alan Johnson added information about the exploitation of urine analysis costs, and even some programs that began billing insurers for allergy and DNA testing. Aronberg states:
“We have a doctor who billed $7 million in nine months for allergy tests.”
Needless to say, the task force and state officials had their work cut out for them.
The ACA, ADA, and FHA
When talking about the many scams being run by various illegitimate businesses, the conversation came back to insurance and how these cons run. Here Dave Aronberg talks about his beliefs on how the law should step in and help restructure the current system.
“Number one: Change the Affordable Care Act’s fee reimbursement model to an outcome-based reimbursement model. Where the good providers are rewarded and the bad ones are paid less. Right now, the opposite occurs, so the more times you fail, the more money you get. There’s an incentive for more services and for more relapse. That shouldn’t be.”
After talking about the issues with the ACA, he talked about the ADA and FHA.
“The second change we need is this: the Americans with Disabilities Act and Federal Housing Act have been misused and exploited by bad actors who own flophouses.”
He went on to say,
“Local governments are largely prohibited from overseeing the sober home industry. If they want to require mandatory inspections, certifications, and registrations, they’re likely prohibited under federal law.”
In essence, Aronberg believes the law should allow local governments to create their own guidelines for health, safety and the general welfare of the patients. None of these demands seems outlandish, and with reasonable regulation, the reputable and effective providers in this industry can continue to best serve the South Florida recovery community.
Aronberg also points out that the problem is not only in Florida. Recently, he went to Orange County, California to meet with officials dealing with the same situation. Next for Dave Aronberg is leading the national task force of 34 prosecutors in 30 states. Their goal is to produce a working paper for setting best practices for prosecutors all over America concerning these issues. The task force also intends to make suggestions for changes to federal and state laws.
What might be most surprising though is the mention of harm reduction strategies?
“It’s about prevention, drug treatment, and innovative strategies. I think it will be powerful because it’s going to be prosecutors talking about needle exchanges and disposal and safe injection sites. People assume prosecutors are going to be focusing only on mandatory minimums and longer sentences. That’s not what this is about. I think it’s going to surprise people.”
While needle exchanges and safe injection sites have been proposed in numerous states, it is not the most popular idea. San Francisco is actually on track to open the first safe injection site in America, with Philadelphia not far behind, and Seattle and Baltimore in the conversation as well.
With Aronberg and the task force working to make a difference, hopefully, we will see the right change soon. We hope it will make the recovery community stronger as a whole. Reputable and respected providers are also doing their part to refine their practices while implementing innovative and effective resources to ensure that those who with drug or alcohol addiction always have a safe place in Palm Beach County to get the help they need. With the opioid crisis ongoing, having real resources for opioid treatment is still an essential part of overcoming the problem.
Palm Healthcare Company is a leader in holistic addiction treatment with over 20 years of helping people from all over the country heal mind, body and spirit. Providing safe and comprehensive care should always be a focus in the effort to overcome the drug problem, and preservation of life should always be a priority. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-888-922-5398
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Safe and effective treatment for drug and alcohol addiction is paramount to creating lasting transformation in the lives of those who are struggling. Providing powerful therapeutic resources with education and innovation makes a significant impact on those who have the opportunity for quality care. An essential part of this process is an active relapse prevention program.
Relapse prevention is a system that influences many aspects of individual recovery from addiction. So what is a relapse? And what makes a relapse prevention program so indispensable?
Relapse Prevention: What is Relapse?
First, let us look at the most basic definition or relapse. If we break it down a little we can better understand what it means and how it happens.
- In general– a relapse is to suffer deterioration after a period of improvement.
- With medicine– relapse is also referred to as recidivism or a return to a past condition.
- In the context of drug use (including alcohol) – relapse is a reinstatement of drug use and drug-seeking behavior. It is the recurrence of pathological drug use after a period of
So the common thread here is that a relapse is when someone:
- Experiences a period of improvement from a problem…
- Is healing from a previous condition…
- Has a period of abstinence, then they experience a recurrence of the initial problem/condition
With addiction, relapse means someone ends a period of improvement and falls back into drug-seeking behavior or even drug use. When you are recovering from a serious addiction, drinking or consuming a drug can sometimes be referred to as a “slip” but it is essentially a relapse. Many recovery advocates and experts are of the opinion that “recovery” means making improvements to behavior, not just abstinence. Therefore, they might say the “real relapse” actually starts when the behavior regresses to the old destructive or compulsive patterns. Some will warn you that you are in the process of a relapse without having used drugs.
Whether you believe the relapse is the behavior or the actual physical manifestation of using narcotic drugs or drinking, you can still see the real value in offering relapse prevention strategies to help avoid either circumstance.
Relapse Prevention: Knowing the Signs
The following are a few signs or behaviors that might indicate that someone may be in the process of a relapse.
When someone is experiencing low moods and lack of energy they might be in a state of depression. Other mental health disorders may begin to intensify and thoughts of suicide may also occur.
Everyday difficulties that occur regularly become overwhelming. The most basic problems can’t seem to be solved.
The individual may begin to avoid social or personal activities they once enjoyed, isolating and ignoring their responsibilities.
Someone in the stages of relapse may become irritable or even confrontational without reason.
The person may rationalize or minimize any attempt at acknowledging and addressing their behaviors.
When Post-acute withdrawal syndrome (PAWS) sets in someone can be at a higher risk of relapse. They can have trouble with memory, emotional overreactions, and sleeping problems, become accident prone or overwhelmed by stress.
Lack of Control
Food, sex, caffeine, nicotine, work, gambling, or other activities become out of control. Their compulsive behaviors become consistent without thinking about the consequences.
Feeling of Immobilization
Immobilization is that feeling of desperation. People feel trapped and start to think that there is no way to solve their problems other than using or drinking.
When experiencing cravings someone may convince themselves the only way to feel better is to use or drink, and they try to justify it.
Abandoning Support System
If someone is in the stages of relapse they may begin to ignore their support systems. They might stop attending support groups, therapy or communicating with their sponsor or loved ones.
Chemical Loss of Control
In a relapse, someone recovering from addiction will eventually begin using drugs or alcohol again to solve problems, even if these problems are only being made worse by their use.
Any combination of these symptoms could mean that someone is headed towards a relapse. In some cases, they may have even relapsed already.
Taking action before someone even comes close to a relapse can make all the difference between lasting recovery and dangerous regression. An effective drug and alcohol treatment plan will include a relapse prevention program in order to help people create a solid foundation from which they can build a sustainable recovery.
Understanding the signs of relapse and the serious risks of going back to drug abuse can help someone who may be struggling in their recovery to stay grounded. It is more difficult for someone to know how to take action, and what kind of action to take if they don’t have an understanding of addiction. Palm Healthcare Company places tremendous value on the importance of education in relapse prevention.
In respect to education about relapse, people should also be made aware of the difficulties they may experience with post-acute withdrawal syndrome (PAWS). When people can anticipate or at least understand the difficulty they may experience with PAWS, they can prepare themselves with healthy and preventative strategies.
Relapse prevention programs should also teach each individual new coping skills to utilize in challenging times. When someone is struggling with their recovery, they should have resources available to them to keep themselves accountable. It is vital that people be taught new and productive methods for recognizing things that are bothering them and addressing them.
Another huge aspect of protecting yourself from relapse is to establish strong habits that keep you to be as mentally and physically healthy as possible. It can be regular exercise, better eating, social and personal relationships, or pursuing your passion or continuing your career. Find a way to care for yourself so that when your recovery is threatened you care enough about your life to protect it.
Having people that support you can make it easier to overcome adversity when it presents itself. When someone has to deal with their troubles alone they may not always see the whole picture; they may not see all the ways to address the issue. Having a support group or a therapist are just a few ways someone trying to recover from drugs or alcohol can make sure they have a safety net in place.
Palm Healthcare Company believes in helping each individual to create a personal plan for recovery that includes relapse prevention and continued support. Our facilities all emphasize the value of comprehensive education, awareness, coping skills, self-care, and aftercare. The solution to drug and alcohol addiction doesn’t end with eliminating the substance, that is only the beginning.
In the event of a relapse, getting the individual to go into an addiction treatment program can be the best way to help them before things get too bad. Getting them back on the road to recovery is crucial, and be sure to look for a program that has a comprehensive relapse prevention program.
Relapse is NOT necessary for recovery, but relapse prevention is. Even if you or someone you love has relapsed, there is still hope to take action that can help you create lasting recovery. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-888-922-5398
In 2015 the Journal of Employee Assistance published an article to help Employee Assistance Programs (EAPs) looking for addiction treatment programs to recommend for their clients. Guess what, challenge accepted!
When we at Palm Healthcare Company took a close look at the outline provided by the Journal of Employee Assistance on methods of treatment, we were happy to note that our treatment programs fit the description perfectly.
It is important for employers and their assistance groups to have a clear and comprehensive idea of what an effective addiction treatment program looks like, so they can provide their employees with options for quality care. The Journal of Employee Assistance article goes on to identify some of the aspects of the addiction treatment outline for EAP professionals should consider as vital for effective recovery. In order to make confident recommendations, Palm Healthcare Company also believes EA professionals should do all they can to understand all levels of care and the methods of treatment.
We understand and appreciate the power of information. Let us provide a detailed look, point-by-point, at how Palm Healthcare Company can best serve your clients by meeting the suggested specifications of the Journal of Employee Assistance.
As stated in the article by the Journal of Employee Assistance, the current focus for treatment of chronic diseases like addiction is based on dynamic treatment, also known as adaptive interventions or multi-stage treatment strategies. The idea is to continuously evaluate the individual’s progress in order to adjust their treatment.
One-size-fits-all tactics fail to address unique life issues that are connected to substance use and addiction. Personalized treatment that is tailored to each individual’s specific needs is a crucial element to effective holistic treatment.
In fact, the National Institutes of Health have stated that the best programs provide a combination of services that take into account all aspects of the individual, including:
Palm Healthcare Company does not believe in the ‘one-size-fits-all’ model of treatment. We know that every person has their own unique experiences and circumstances. We all live and learn differently, so addiction treatment should take those differences into consideration.
Palm Healthcare Company, like most traditional programs, provides the basics of addiction treatment. Looking at the addiction treatment outline for EAP professionals, the most traditional methods to look for include:
All detox facilities are staffed with medical professionals experienced with treating those struggling with drug or alcohol addiction. Every individual is given a thorough intake assessment to ensure the safest and most comfortable method of medical detox is offered to fit each client.
Because addiction is about far more than substance use, behavioral therapy is extremely important to the recovery process. Not only do these sessions examine destructive behaviors, but they also assess the thoughts and feelings that might cause them.
As part of offering behavioral therapy, Palm Healthcare Company facilities also offer unique classes on building social skills and personal development opportunities.
Palm Healthcare Company also believes that a crucial aspect of overcoming addiction is to understand it through educational, evidence-based therapeutic intervention. Classes are consistently provided explaining various aspects of addiction and mental health disorders so each individual can better understand and cope with their illness.
Support groups and 12 Steps
Historically, group therapies and a sense of community has always been a big piece of addiction recovery. Opportunities to get involved with 12 Step fellowships and other support groups can help individuals to find a sense of community with others recovering from drugs or alcohol. Palm Healthcare Company programs consistently facilitate these options.
Family weeks or weekends for those over 13 years old
The Palm Healthcare Family Program is a unique and empowering experience for individuals trying to overcome their addictions, as well as for their loved ones. Part of the family program is the Palm Healthcare Family Weekend which includes various events designed to educate family members and bring each other closer through connection and support.
However, the Journal of Employee Assistance notes that the more “novel yet effective” programs also include more innovative addiction treatment methods. These facilities go above and beyond the basic outline of services to provide holistic treatment programs. So how does Palm Healthcare Company match up to these recommendations?
A range of therapeutic approaches
Again, Palm Healthcare Company does not believe in the ‘one-size-fits-all’ approach to treating addiction. Because not every form of therapy will be as influential for everyone our facilities offer a variety of therapeutic courses. Some of these include:
Palm Healthcare Company believes in utilizing cutting-edge treatment methods to create a more in-depth and personal recovery experience.
Provide multiple levels of care
There are several reasons why having different levels of care can be a big deal for EA professionals seeking treatment providers. For one, different levels of care allow for different levels of contact with the outside world.
With partial hospitalization, intensive or residential levels of treatment there is a much more secure and controlled environment with daily schedules full of therapy options and courses. If the individual is approved for Outpatient or Intensive Outpatient treatment they can attend work for part of the day while attending classes periodically.
Palm Healthcare Company helps the patient choose the level of care that is best suited for their needs. Monitoring individual progress and adapting the aspects of treatment to fit their progress is an important way to personalize the experience and support the transition from addiction to independent recovery.
Treat co-occurring mental health disorders
When an individual is struggling with a mental health disorder and substance use disorder the best method for them is dual diagnosis treatment. This allows the individual to address the addiction and the co-occurring disorder individually and simultaneously for a complete recovery.
Palm Healthcare Company understands that if someone only addresses one disorder without the other then they are more likely to have difficulty maintaining their recovery. These conditions tend to feed off of one another, and one going untreated can cause a relapse in the other.
Address underlying issues related to addiction
Palm Healthcare Company also cares a great deal about understanding substance use disorder; where it comes from and how it influences the lives of those who suffer. Therefore, we believe in exploring each individuals experience to help them find out what underlying issues are connected to their drug or alcohol use.
Addiction is such a complex disorder. There is no one way that someone ends up addicted. While there is a genetic predisposition, there are numerous other factors that contribute to the development of substance use disorder. Because things like trauma and family dynamics play a big part in the development of addiction, an effective treatment program should also examine and address these issues if the patient is going to experience lasting recovery.
Involve the entire family, including children
The Palm Healthcare Family Program is committed not just to offering brief visits with loved ones. Our Family Program is designed to:
- Give the family essential educational information
- Establish deeper connections between loved ones through recovery
- Teach about emotional well-being and healthy boundaries
- Offer life-changing breakthrough experiences
- Create a strong support system
The Palm Healthcare Family Program is a FREE service offered by our facilities because we believe that family involvement is incredibly important for lasting and worthwhile transformation.
Explore performance at work
Clients who are professionals are often very focused on how their substance use affects their career. Along with life skills and behavioral therapy, there is an important element of understanding how addiction impacts your professional life. Everyone from CEOs and executives to labor workers in every industry needs to be aware of how addiction affects the workplace.
Of course, EA professionals are more likely to recommend a treatment program that pays attention to addictions impact on the workplace. So teaching clients how to safely and effectively transition from treatment back to work is an important element of these programs.
Examine legal and financial issues resulting from addiction
Our facilities also take pride in providing teams of skilled individual case-workers who consistently work on behalf of each individual to maintain their personal interests regarding legal issues or other concerns they may have. It is important that an addiction treatment provider has experienced staff members who understand the difficulties that can arise from substance use and know how to best support each individual with these concerns.
Working with the Workforce
All Palm Healthcare Company facilities provide the more holistic and effective approach through this criterion of additional services. We know that addiction is an illness that impacts every walk of life. It also impacts any career position in every industry. We work every day to provide safe, effective and personal recovery plans to every individual we come into contact with.
Another part of providing recovery options to professionals can be to allow EA professionals to get involved in the aftercare process. An EA professional can inquire about policies relating to communication with the source of the referral. If the appropriate consent is given, the EA professional themselves can even become an important part of the recovery team for helping create a discharge and aftercare plan.
Looking at these very important suggestions coming from the Journal of Employee Assistance we are confident in our dedication to providing revolutionary and holistic care above and beyond the addiction treatment outline for EAP professionals. Palm Healthcare Company wants to support you and your clients to create a happier and healthier future. Please call toll-free now for more information.
CALL NOW 1-888-922-5398
At a time like this in America, no one should be naive to the reality of addiction and the devastation it brings. The opioid epidemic impacts people in every city in every state; whether it is through prescription painkiller abuse or heroin and potent synthetic opioids like fentanyl on the illicit market. Meanwhile, methamphetamine use has also continued to grow steadily in the background. Other prescription narcotics have become more and more prevalent with misuse, and alcohol remains a legal drug both frequently abused and deadly. Something equally as important as acknowledging addiction is being aware of the options in addiction treatment.
One thing we have to continue to promote is that people seek help, regardless of who they are, where they’re from or what they think they can afford. Expenses can be an important factor for each individual when trying to find treatment; therefore it is important to remember there are always options available regardless of financial status. At the end of the day, everyone deserves a chance at making it through their adversity.
While the options may be different, they are still out there.
State Funding Rehab Facilities
For those who are extremely limited in their resources the most attainable option may be to pursue a state-funded program. State-funded rehab facilities are cost-free, which is the greatest advantage to seeking help through these programs.
Most states have some form of government-funded addiction treatment. Sadly, some people still see a stigma attached to public assistance programs and they allow it to keep them from getting help. However, for the individual who has little to no income, or with inadequate to no insurance coverage, these organizations provide detox, treatment and support services. State-funded rehabs are often included in other state services such as:
- Child social services
- Criminal justice and prison provisions
The funding for treatment may be included as part of these other initiatives.
Some states will offer a variety of therapy options with state-funded programs. Others might not have as many due to limited funding. Some state facilities will not necessarily have access to the same technologies and treatments as private treatment providers.
Private addiction treatment programs often have unique services depending on their approach and treatment model. However, some people still find that state-funded programs are effective in helping them get their start.
Medicaid for Addiction Treatment
One thing that can be a real help to those who are unable to afford a higher level of insurance coverage is access to state-funded health insurance programs.
Medicaid coverage for no insurance rehab is a useful option. Medicaid and Medicare may actually cover both detox and inpatient addiction treatment. Some may even cover outpatient care depending on each programs requirement for eligibility through the state. Through Medicaid or Medicare, an individual who has very limited resources may receive free or low-cost addiction treatment.
Under the Affordable Care Act (ACA) or what some call “Obamacare” insurance providers are required to cover all basic aspects of drug and alcohol dependency recovery. Medicaid covers:
Maintenance and craving medications
Long-term residential treatment
Other mental health services
In most states, Medicaid recipients don’t even have to worry about a copay for addiction treatment services.
Medicare for Addiction Treatment
Medicare is available for anyone:
- Over 65 years old
- With a disability
Medicare does have a monthly premium, but that amount is also based on the individual’s income. So if you make less money you pay less for your coverage.
Inpatient and outpatient treatment can be covered by Medicare. This coverage is provided in a four-part system:
Medicare Part A
Insurance for hospital stays covers up to 60 days without copay with no deductible. But Medicare only covers up to 190 days for a lifetime.
Medicare Part B
This can cover outpatient addiction care at up top 80% of the costs. This includes coverage for therapy, professional interventions, and drugs administered via clinics. This also covers co-occurring disorders like depression.
Medicare Part C
This is Medicare-approved private insurance for those who want to opt for more benefits. It does include more out-of-pocket costs and coverage can vary.
Medicare Part D
Medicare Part D coverage will help cover the cost of addiction medications. Specifically, this form of Medicare helps with medications used to combat cravings and withdrawal symptoms.
Someone who is eligible for Medicaid and Medicare can actually apply both forms of coverage to their addiction treatment. If you believe that you qualify for these insurance opportunities you can contact a caseworker for assistance with an application.
Once you have obtained coverage for any of these programs, you can research online to find facilities that accept these forms of insurance.
Keep in mind, not all facilities accept Medicaid or Medicare.
Individual Health Insurance
When examining the options for addiction treatment people who have health insurance, whether privately or through their employment, should research the coverage available through their insurance provider.
The Mental Health Parity and Addiction Equality Act of 2008 mandates that health insurance companies to balance the alcohol and drug treatment for group plans to the stipulation for standard medical rehab.
Because substance abuse and addiction are recognized as medical conditions, insurance companies have a responsibility for covering the cost of addiction treatment. Substance use disorders are better understood today for their effects both psychiatrically and physically, so major insurance providers make a point these days to offer terms for partial or complete coverage of options for addiction treatment. Many times this coverage will allow for access to quality holistic treatment programs.
Too many people don’t know the extent of which their own insurance covers them. Find out what services are covered by your policy when seeking out care for substance abuse. As far as employers go, your right to addiction treatment is protected by FMLA, while the details of these protections and provisions may differ depending on the state or the individual companies policies.
Private Pay Options in Addiction Treatment
Of course, health insurance is not required to obtain addiction treatment services. Not everyone has insurance, or their insurance might not provide the coverage they need. There are also facilities that cater to a private pay demographic.
All across the country, there are addiction treatment facilities that offer different levels of high-quality and luxury treatment options for those who would prefer to pay cash for services. Many patients who chose to private pay do so for a variety of reasons, and they often find that they require a combination of treatment methods, including:
Intensive one-on-one counseling
Private recovery coaching
Of course, different programs have their unique advantages and disadvantages. However, those who chose to private pay for addiction treatment often do so because they are looking for a very specific approach with a very specific criterion that caters to their own needs.
Executive Treatment Programs
Executive treatment programs are another one of the options in addiction treatment. These facilities cater to clients that wish to pay more for a more private environment with more luxuries. Executive programs are more expensive and are more commonly utilized by CEOs, high-paid professionals, and celebrities.
Many programs that offer executive options for addiction treatment allow for those receiving care to continue working with their businesses or clients while attending individual therapy, support groups, and holistic treatments.
Help is Out There
Addiction is everywhere. Sadly, there are not as many resources as many recovery advocates believe there should be. It is easy to feel overwhelmed when trying to find help with addiction and recovery.
But help is out there.
There are accredited holistic treatment programs that maintain their integrity by providing quality care to their clients. These facilities provide high-level services in a safe and comfortable environment while staying at the edge of innovations in treatment. While not all of these companies advertise their contributions, many even provide scholarship opportunities for those who cannot afford treatment to have access to their programs.
Meanwhile, we should all look to our politicians and public health officials to create even more options for addiction treatment. Until more support and funding is available for expansion of options for addiction treatment, the resources we have now do everything they can to make a difference.
Palm Healthcare Company has made a commitment to provide effective, innovative and holistic addiction treatment options to those still suffering with substance use disorder. 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
With substance use disorder and addiction being such a prevalent problem in America, we think it is crucial for people to understand substance use and addiction as best as they possibly can. Part of looking at which professions have the highest rate of substance use disorder is not just about making people aware of how common it is in the workplace, but also to break the stigma of substance use disorder and show that drugs and alcohol impact people in every workplace, from entry level to executives.
Resources of Substance Use Rates
In April of 2015 the Substance Abuse and Mental Health Services Administration (SAMHSA) released a survey that combined data collected by the National Survey on Drug Use and Health (NSDUH) from every year between 2008 and 2012 to find out which professions held the highest rates of:
The NSDUH assess symptoms of dependence or abuse of alcohol or drugs through a series of questions included in their survey. The questions are based on the criteria described by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It defines illicit drugs as:
The NSDUH uses the definition of heavy alcohol use of:
- 5 or more drinks on the same occasion
- 5 or more days in the past 30 days
The rating system includes full-time workers from age 18 up to age 64.
Which Jobs Have the Highest Rates of Substance Use Disorder?
In the following categories, number represents the percentage of works out of all those surveyed between 2008 and 2012.
Heavy Alcohol Use
- Mining workers- 5%
- Construction- 5%
- Accommodations/Food Services- 8%
- Arts/Entertainment/Recreation- 5%
- Utilities- 3%
- Wholesale trade- 2%
- Management/Administrative support/waste management- 9%
- Manufacturing- 7%
- Agriculture/forestry/fishing/hunting- 4%
- Retail trade- 0%
- Transportation and warehousing- 8%
- Other services (except public administration)- 5%
- Real estate/rental/leasing- 5%
- Information- 1%
- Professional/scientific/technical services- 7%
- Finance and insurance- 4%
- Public administration- 6%
- Educational services- 7%
- Health care and social assistance- 4%
Illicit Drug Use
The overall rate of illicit substance use among full-time workers, between the age of 18 to 64 years old, who admitted to having used within a month of taking the survey was 8.6% of workers. That may not seem like a lot, but when you consider that is a percentage of ALL professions it is actually a lot bigger than you think.
- Accommodations and food services- 1%
- Arts/Entertainment/Recreation- 7%
- Management/Administrative support/waste management- 1%
- Information- 7%
- Construction- 6%
- Other services (except public administration)- 2%
- Real estate/Rental/Leasing- 9%
- Retail trade- 3%
- Professional, scientific and technical services- 0%
- Wholesale trade- 8%
- Manufacturing- 4%
- Finance and insurance- 5%
- Utilities- 1%
- Transportation and warehousing- 9%
- Agriculture/Forestry/Fishing/Hunting- 7%
- Health care and social assistance- 5%
- Mining- 0%
- Educational services- 8%
- Public administration- 3%
Substance Use Disorder
When it comes to substance use disorder the data is collected for full-time workers from age 18 to 64 that fit the criteria for substance use disorder within a year of taking the survey. The rates of substance use disorder in different professions include:
- Accommodations and food services- 9%
- Construction- 3%
- Arts/Entertainment/Recreation- 9%
- Mining workers- 8%
- Utilities- 5%
- Management/Administrative support/waste management- 4%
- Retail trade-5%
- Agriculture/Forestry/Fishing/Hunting- 5%
- Wholesale trade- 4%
- Other services (except public administration)- 1%
- Real estate/Rental/Leasing- 0%
- Information- 8%
- Finance and insurance- 4%
- Manufacturing- 3%
- Transportation and warehousing- 1%
- Professional, scientific and technical services- 8%
- Public administration- 2%
- Health care and social assistance- 7%
- Educational services- 5%
Different Job Substance Use Trends
When looking at these rankings we can see a few professions that are consistently represented in the top five of all three categories.
NOTE: Remember the top ranks are not based on the overall number of users, but on the percentage of the total industry.
#1 in Heavy Alcohol Use– Mining Workers
121,000 mining workers that were surveyed contributed to the top ranking percent in an industry for heavy alcohol use. This number may seem small compared to the high numbers of heavy alcohol use in other professions. But think of it like this- If there are:
- 100,000 nurses and 70 of them drink heavily
- 100 miners and 70 of them drink heavily
Which would you think it a bigger issue?
#1 in Illicit Drug Use– Accommodations and food services
Accommodations and food services came in as the top rated profession for illicit drug use. According to the numbers of all those in this industry measured, approximately 1,169,000 were recorded for illicit drug use within a month of the survey.
This statistic does not change when accounting for gender or age differences. What this suggests is there may be something unique about this industry and how people end up using drugs more often working in accommodations and food services more than anywhere else.
#1 in Substance Use Disorder- Accommodations and food services
In terms of substance use disorder the accommodations and food services industry again come in at the top of the list. This time, the numbers of those surveyed shows that approximately 1,038,000 people in this profession actually fit the criteria from the DSM-IV for substance use disorder.
But unlike with illicit drug use, this rating did not stay the same when adjusting for age or gender differences. So what does that mean?
It means the higher rates of substance use disorder in the accommodation and food industry depends on the demographics employed in that industry. For example, if you look at age:
- 18-25 years old this industry is number 2
- 26-34 years old its number 1
- 35-49 years old this industry is number 3
- 50-64 years old its only number 11
So What Jobs are the Worst for Substance Use Disorder?
The big thing here is we must acknowledge that there are variables like age and gender that actually will make a big difference as to which jobs are ‘worse for substance use disorder’, while also recognizing the issue of substance use and addiction is not one size fits all. It is a different story for every individual. There is a formula that takes environment into account, but that formula is not the same for everyone.
A young woman working in the accommodations and food services industry might have a harder time staying off drugs than she might as a school teacher… or maybe not. Young men working in social assistance might find it a lot easier to stay off of drugs than one working in construction. It isn’t a guarantee, but it is a trend we can note.
So, does your job put you in an industry with higher rates of drinking, drug use or addiction? Are you more likely to have co-workers or employees that struggle with substance use than in another position?
With data like this we have to ask- does the job make an impact?
When we consider how central our jobs are to our everyday lives, we should take into account what kind of workplace we put ourselves in and what we have to offer. It is the same thing for those of use trying to work toward recovery. Substance use disorder recovery can be a lot of work, but it is definitely worth the livelihood you stand to gain from it. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.
CALL NOW 1-888-922-5398