Parity Questions:

Why don't Addictive disorders receive coverage on the same basis as for any other medical care?

Prevention and Treatment work so why aren't health insurer's providing these services?

How do we advocate to get coverage for drug dependencies and receive health care coverage that is non-discriminatory?

Alcoholism and Addiction do not get coverage from Insurance companies at the same benefit level as other chronic diseases?  Seems hard to believe, and now finally it seems
there is a movement to change available benefits for substance abuse treatment.

There is a  need for parity in our nation's healthcare industry,   Alcoholism and Addiction treatment services merit coverage from health insurer's, just as any other disease,  currently receiving coverage for treatment. Diabetes, is often a comparable disease when we hear "Chronic disease that responds to treatment and prevention services".  Just imagine if insurance companies suddenly said, "Sorry, we no longer will cover any treatment services related to Diabetes!" There would be great outrage.

 

Unfortunately those suffering from addictive disorders, have faced enormous social stigma, so much so that Insurance companies have been able to discriminate, and deny coverage in this area.    

The bottom line is that addiction treatment services are  not a morality issue. Not any more than Diabetes, or the need for ongoing insulin, checkups, etc.   This  "disease", has an enormous effect on our social systems.  Many barriers have kept effective treatment from being made readily available, one of those is a lack of parity for health insurance benefits.  Solutions to chronic diseases, require comprehensive and ongoing treatment services. Countless studies have shown how cost effective treatment and prevention services are( especially compared to the staggering costs of untreated Addiction,  more than $400Billion in the U.S.) American's are in need of treatment services, like it or not, it is a reality, we must face or the continued drain on social systems will begin to bankrupt state budgets, trying to "clean up" a preventable, treatable mess.  We should support  our policy makers,  with education and information, and that  is our purpose, to bring education and information into public view, that will reduce the stigma, and empower policy makers, while increasing the  possibility for Parity with Health Insurance to become reality. Samantha-Hope Atkins

 

From the American Society of Addiction Medicine ASAM
 

"Benefit plans for the treatment of addictive disorders, in both the public and private sectors, shall be comprehensive; i.e., they shall cover the entire continuum of clinically effective and appropriate services provided by competent licensed professionals, and should provide identical coverage and funding to those benefits covering physical illness, with the same provisions, lifetime benefits, and catastrophic coverage."     Parity support and advocacy statement  AMBHA and ASAM

The Nature of the Problem

As America continues to confront unprecedented problems from the wide spread prevalence of alcoholism and other drug dependencies and the annual direct and indirect costs these problems create, access to treatment for addictive diseases is becoming increasingly important. Many persons in need of such treatment are covered for their overall health care by a variety of public and private third-party payment plans that severely restrict or exclude addiction treatment services, thereby denying patients access to quality care. These patients face limits on duration of treatment and on total dollar benefits that are far narrower than the limits placed on other medical care they receive.

AMBHA and ASAM have joined together in acknowledging that a disparity between health benefit coverage for drug dependencies and other medical care exists, to declare our opposition to such discriminatory benefit design, and to emphasize that treatment of drug dependencies is cost effective.

Drug Dependence, a Chronic Medical Illness  Implications for Treatment, Insurance, and Outcomes Evaluation  The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O'Brien, MD, PhD; Herbert D. Kleber, MD The Logic (Why Parity is a MUST) Purchasers and public policy makers should consider the following logic and current state of practice: 1. health insurance provides financial coverage for diagnosis, treatment, and prevention of acute and chronic diseases 2. addiction medicine is involved in the diagnosis, treatment, and prevention of substance related disorders, which are acute or chronic diseases 3. addiction is a complex neurobehavioral disorder, involving biochemical abnormalities of the brain that involve reinforcement and reward systems of the central nervous system; addiction is manifested by aberrant behaviors that can compulsively persist despite adverse consequences from those behaviors; addiction is not a character weakness. 4. addiction diagnosis is objective, standardized, and scientific, no less so than for other chronic diseases 5. addiction treatment is effective 6. barriers to effectiveness of addiction treatment are the same as barriers to effectiveness of treatment interventions for other chronic diseases: patient compliance and readiness to change, socioeconomic complications to care -delivery and management, and co-morbid emotional-behavioral conditions all adversely impact treatment success for substance addiction and for other chronic illnesses. There is nothing intrinsic to addiction treatment that should generate pessimism about treatment efficacy rates, and such pessimism is not supported by clinical research or experience. 7. relapse is inherent in addictive disease, but also inherent in virtually all chronic disease; relapse is usually a sign of chronicity, not a sign of treatment failure. By relapse, we mean a return to the signs and symptoms meeting criteria for a substance use disorder, not a return to use per se. 8. insurance benefits for addiction treatment should be equivalent to benefits for the treatment of other chronic diseases 9. treatment for the disease of addiction is cost-effective, and can be cost-saving for the health care system overall 10. because of medical cost offsets, to NOT treat the disease of addiction is costly - economically as well as socially; benefit structures should not create barriers to effective intervention to diagnose and treat addiction Action Steps: A national dialogue must take place among consumers, family members, professions, managed care organizations, employers, and state and federal government addressing the following critical issues: 1. In an environment of global competition, increasing health care needs ,an aging population, and constraints on tax revenues, we need to identify best practices that demonstrate comprehensive coverage and its affordability, and we need to encourage the adoption of these best practices in public and private benefit plans. 2. We need to reduce the amount of variability between states regarding the interpretation of parity legislation, increase the consistency between various state laws on this issue, and prevent legislation on federal and state levels that inhibit the adoption of the best practices we have  identified. 3. It is necessary to achieve consensus on what it means for a service to be "medically or clinically necessary", "appropriate" and a legitimate use of a benefit plan for behavioral health problems and services. Adopted by the ASAM Board of Directors October 1997 & AMBHA Membership October 1997 Additional ASAM links: Profiles Addiction is a Brain disease State ASAM Directories Back HN Home More on Alcohol

JAMA. 2000; 284:1689-1695