Insurance a major obstacle for private substance abuse treatment centers

Dr. Charles J. Shaw, a medical doctor who deals exclusively with addicts, says insurance companies rarely cover extended stays in substance abuse treatment programs.

The problem with that, Shaw says, is that longer stays in treatment result in higher rates of success.

“There's no question,” he said. “The longer you stay the better.”

Shaw, who has treated more than 100,000 drug addicts and alcoholics over the past 23 years, has his own practice in Oklahoma City and also works at a major hospital. In addition, he writes a column that can be found on knowit.NewsOK.com/addiction-oklahoma.

Shaw says most of the patients he sees are struggling with addiction to opiates, and the individuals seem to be getting younger and younger.

Some insurance companies won't pay for opiate abuse treatment, Shaw said.

“And I'm talking about good insurance companies, but that's their policy,” he said. “Most of them will allow for alcohol ... because it's been around longer, I guess, and it's kind of written in so to speak.”

If insurance companies do agree to pay for treatment, Shaw says, it's usually “just for a couple of days of detox, which just isn't enough time for many of these addicts.”

Nicole Amend, a spokeswoman with Blue Cross Blue Shield of Oklahoma, said the state's largest health insurance company covers extended stays in drug treatment centers “when medically necessary.”

And as for discriminating against patients based on their age and drug of choice, which Shaw said some companies are doing in Oklahoma, Amend offered a statement.

“When seeking treatment for an addiction, behavioral health coverage is not dependent on either the member's age or the type of substance addiction,” she said. “However, the type of substance and the member's age may impact the appropriate treatment option available.”

Harold Pollack, a professor at the University of Chicago familiar with the issue, said insurance companies have long “clamped down” on things like long-term drug and alcohol treatment stays.

“That's one of the major ways those companies control costs, by scrutinizing inpatient care. It's no secret,” he said. “On the one side, there are cases when people have been over-treated, especially adolescents or young patients, but the downside is that many people who legitimately need treatment aren't getting it.”

He also said one explanation for the rise in refusals reported by Shaw is the size of the painkiller epidemic in the United States.

“There are just more and more people with these issues,” Pollack said. “So, you're going to see more and more people get turned down, depending on their health care coverage.”

Shaw, who is a recovering alcoholic with 28 years sobriety behind him, says insurance companies should pay for longer stays because they are more effective and could save the very same companies money in the long run.

“They're going to pay sooner or later, when the person gets sick,” Shaw said. “And they will get sick, they will overdose, they will end up in the emergency room.”