Renewed Faith in Insurance Coverage for Addiction Treatment
By Sarah Benton, MS, LMHC, LPC
Throughout my career, I have worked at various outpatient and residential treatment centers for mental health an addiction- some insurance based and some self-pay. I have witnessed staff conduct utilization reviews advocating for additional days of treatment for clients who were desperately in need—sometimes successfully and sometimes not. Given the amount of money that insurance companies spend on repeated client relapse/detoxification, ineffective treatment and other medical complications related to relapse and untreated addiction one would think that they would become more open-minded to what treatment they are covering. At times, it doesn’t feel that Parity Laws (those that mandate for equal coverage of both medical and mental health care) are being implemented.
I recently became the Director of Clinical Services at Aware Recovery Care (ARC), home-based addiction treatment program serving all of Connecticut. This year-long program provides in-home care facilitated by Certified Recovery Advisors, Care Coordinator nurses, administers drug testing and sets clients up with outpatient therapy, psychiatry and family therapy in their local community. Individuals can attend residential treatment first and then step down to ARC as their aftercare plan or begin initially with the ARC program. The home becomes the treatment center, and clients receive a 52-week curriculum and care tailored to the needs of individual and his or her family system. The miracle is that Anthem Blue Cross recognized that covering a year of comprehensive addiction care (in-network) for individuals in their home environment (where many struggle to remain sober) is a worthwhile investment for them. I have witnessed this insurance company make this process easy for clients and for ARC, in that we do not need to fight them every month to get approval for more services—as it is expected that each client will receive the entire program. I know- it sounds like I am making this up- but it is real!!! Anthem Blue Cross is also planning to cover a year of the ARC program in other states starting with New Hampshire. These events are giving me a glimmer of renewed faith in the insurance industry—that they are acknowledging the addiction epidemic and are willing to take a chance on covering non-traditional services in order to help their members increase chances of recovery.
Maybe this will become a new trend and other health insurance companies will begin viewing addiction treatment as a long-term investment. The truth is, covering comprehensive services for at least the first year of an individual’s sobriety can increase their chances of long-term recovery and decrease their chances of relapse.
For more information about the ARC program, please visit Awarerecoverycare.com