For all the many reasons why it can be so difficult to make it through substance abuse recovery, being rejected by an insurance company is the last thing anyone should have to worry about. And yet it’s all too common, especially among private insurers, that they will deny coverage for a treatment facility or for addiction medications.
Plans available through the healthcare.gov marketplace are all required to pay for behavioral health treatment and mental and behavioral health inpatient treatment, as well as substance abuse treatment. The specific benefits depend on the plan you choose and the state you live in, but the marketplace requires what is called “parity” protections, meaning that any limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. This covers things like deductibles, copayments, coinsurance, and out-of-pocket limits, as well as the number of visits or days spent in treatment.
Most of these marketplace plans will also cover medications like buprenorphine (suboxone), but it can be a different story with private insurers, and of course for people with no insurance. An article earlier this year in Vox details the struggles of a Chicago woman named Mandy, who struggled with an opioid addiction for six years. At the time of the article, she was two months clean, having been through an intensive outpatient addiction treatment program for eight weeks and was prescribed suboxone, which she was still taking when she transitioned out of the program. Unfortunately, at that point her insurance provider, Blue Cross and Blue Shield of Illinois, refused to pay for the suboxone. The cash price for a 28-day supply was $294, although a discount allowed to her pay $222. A year’s treatment came out to around $2,900.
A little under three thousand dollars for an entire year might not sound like much to some people, but for someone who is living paycheck to paycheck – as people who are recovering from substance abuse often do – it can be a massive strain. It’s particularly problematic when it occurs in the early days of recovery, as this is already an extremely stressful time. In Mandy’s case, she was dealing with household bills, student loans, and other healthcare expenses on top of the cost of the suboxone. It’s counterintuitive, she pointed out, that all those opioids she had taken in the past were free (thanks to her insurance), but the medication she needed to treat her addiction was so expensive.
It’s particularly puzzling that insurance companies wouldn’t want to pay for suboxone or similar medications, as they have been proven to cut the mortality rate for opioid use disorder patients by half or more and keep people in treatment longer than non-medication approaches. People with opioid addictions cost their insurers far more money than they’d spend on the medication because of all the associated health risks.
If you or a loved one need help with quitting drugs or alcohol, consider Asana Recovery. We offer medical detox, along with both residential and outpatient programs, and you’ll be supervised by a highly trained staff of medical professionals, counselors, and therapists. Call us any time at (949) 438-4504 to get started.