Saturday, February 6, 2016

Is Rehab Back, for the Non-Wealthy?

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.