Prior to the large scale entry of managed care into health
care coverage (yes, I’ve been around long enough to remember), mental health/substance
abuse professionals regularly referred actively alcoholic/addicted individuals
to rehab. In fact, the term “treatment”
used to imply rehab, meaning typically a month-long program, often in a very
nice setting. In those days, insurance
covered rehab routinely.
Suddenly, with the advent of mental health managed care
(which happened to come in most aggressively to Massachusetts, a
high-utilization state), suddenly (a) most patient could not be approved for
any kind of inpatient treatment and (b) inpatient care for those with
addictions was usually limited to detoxification (less than a week, and only
applicable to those subject to withdrawal symptoms). As a result, the two most highly regarded
rehabs at the time in New England (Spofford Hall in New Hampshire and Edgehill
Newport in Rhode Island) both folded.
Those facilities that survived received much reduced daily insurance
payments, and were not able to maintain the same quality of care and were not sustained
in the same physical/aesthetic condition.
I became accustomed, for over 2 decades, to telling families
that their alcoholic/addicted members could only go to rehab if they had
significant funds (and of course with no guarantee of success, since
alcoholism/addiction is a condition prone to relapse). Instead, they could get detox, if physically
indicated, at times followed by 2 or 3 weeks at an outpatient day program. (A couple of such programs provide basic
lodging at a nominal fee and can be called “residential”, but do not offer the
kind of 24-hour care available at a rehab – because insurance is paying mainly
or solely for the day program at a fraction of the cost of inpatient
treatment.)
Although I have missed the days when people without a lot of
money could be advised to “go to rehab,” I do understand the reasons why these
changes came along. Health care as a
whole has become insanely expensive (largely because of technology in physical
health treatment), and behavioral health treatment was the easiest to cut
because it is so much less tangible than, for example, treatment for
pneumonia. In addition, at least half of
those who were routinely referred to rehab had a good chance of doing well with
a less expensive level of care. (Not to
mention self-help groups, a key resource that’s free!). But in some cases, especially where less
intensive interventions have resulted in frequent and repeated relapses, it
became painfully obvious that the rich got better treatment. Rehab costs range from something like $20,000
to over $60,000 for a month.
But there seems to be some good news on the rehab
front. I have received no announcements
from health insurance companies about any changes in coverage, but over the
past year patients have begun to report to me that they managed to get covered
for a month in rehab (typically in Florida), suggesting that their Massachusetts
based managed care companies had developed contracts (meaning hefty discounts)
with certain facilities. Even more
recently, a marketing representative from a new detox/rehab in Massachusetts
itself told me that they have been able to serve patients covered by PPO or POS
plans. (In these plans, the patient
usually has a deductible, after which insurance pays something like 80% -- but
that’s much more than zero.) 
Why is this happening?
I can only guess. Certainly,
there has been increasing publicity about the impact of addictions, and it has
become one of our governor’s prime issues as increasing numbers of individual
die of overdoses. (Suddenly managed care
companies that used to allow me about 8 authorized outpatient visits at a time
are authorizing many more, if the diagnosis is alcohol/drug related.) So, to those of you whom I myself may have
discouraged with regard to how much treatment you could get: don’t give
up. Call your health insurance provider
and, if rehab is needed, try to get them to cover it. And please email me to let me know how it
goes, and if they covered a facility that was truly helpful. The individuals and families I see need to
know.
