Gone are the days when addiction was considered a moral failing or a lack of self-discipline on the part of the individual. Today, comprehensive research studies show that an addiction to drugs or alcohol is both a complex brain disorder and a mental illness. Substance use disorders lead to hundreds of billions of dollars of addiction-related healthcare every year. Yet, despite this, substance abuse treatment insurance coverage is traditionally limited or nonexistent.
Throughout our nation, millions of people struggle with substance use disorders. This epidemic is a chronic disease and should be treated as such. A lack of full insurance coverage frustrates and discourages those seeking holistic addiction treatment.
Below, we discuss why public and private payers should ensure patient access to evidence-based, comprehensive addiction treatment.
Substance Use Disorder Is a Disease
Substance use disorders (SUDs) include the misuse of opioids, alcohol and illicit drugs. Most medical associations, including the American Medical Association, now define addiction as a disease. Yet, the stigma and bias directed toward those struggling with SUDs has long prevented addicted individuals from getting high-quality care and insurance coverage.
Like other diseases, including heart disease, cancer or diabetes, SUDs are caused by a combination of environmental, behavioral and biological factors. In fact, genetic factors dramatically increase the likelihood that someone will develop an addiction to drugs or alcohol.
Addiction changes how the brain and body function. While the early decisions to use substances may have been a person’s conscious choice, once the brain has been altered by addiction, their willpower becomes impaired.
People struggling with addiction do not choose how their brain and body respond to these substances. A substance use disorder is a progressive and recurring disease that requires intensive treatment.
Should Medical Insurance Cover the Cost of Addiction Treatment?
For an addicted individual to fully recover from a substance use disorder, they require intensive treatment as well as continuing aftercare. Even the most severe or chronic form of this disorder can be managed and reversed with appropriate care and recovery support.
When payers cover comprehensive substance use disorder treatment, these lifesaving programs are an effective solution to combat the SUD epidemic. Here are just a few of the reasons why insurance companies should consider extending or reforming their current coverage policies.
An Effective Care Policy Has Been Established for Those With SUDs
No matter the severity of the addiction, The American Society of Addiction Medicine (ASAM) has laid out established guidelines to ensure the most effective SUD treatment. They recommend comprehensive services, including:
- Inpatient and residential care
- Services to support long-term recovery
- Pain management best practices
- Access to the FDA-approved medication-assisted treatment, such as methadone, buprenorphine and naltrexone for opioid addiction
- And more
Sadly, many public and private payers fail to cover these evidence-based care guidelines established by ASAM.
Many Covered Treatments and Interventions Have Low or No Value
Instead of covering the ASAM’s evidence-based care guidelines, many insurance companies reimburse patients for services that have low to no value for their overall recovery.
Interventions such as 28-day rehabilitation without medication or 72-hour detox can’t take the place of comprehensive SUD treatment. In fact, struggling addicts often find themselves in the same situation or worse once they complete these non-evidence-based programs.
Comprehensive Treatment Is a Cost-Effective Solution
Public and private insurance companies that ensure full-spectrum coverage for lifesaving SUD treatment services reduce their overall costs.
There is a proven connection between SUDs and mental health. Untreated addiction often leads to other physical and mental issues, requiring costly medical attention. By providing comprehensive, holistic care, including medication-assisted treatment, payers can prevent the development of additional disorders. If left untreated, SUDs can escalate, becoming more severe and far more costly.
Invest in Value-Based Substance Abuse Treatment Insurance Coverage
Health insurance companies all over the country are facing an increase in claims for substance abuse treatment. Now is the time to invest in value-based treatment that gives people a higher chance for a successful recovery.
The addiction crisis in our nation cannot be ignored. Instead, payers must develop guidelines and establish protocols so that doctors and other mental health providers can provide trusted referrals to get addicted patients into appropriate substance use disorder treatment centers.
People with addiction are responsible for seeking treatment and maintaining recovery. However, they need payers to invest in comprehensive SUD treatment to ensure they have access to the best treatment with the highest level of successful outcomes.
If you would like to learn how you can be a part of impacting the survival and recovery of millions of people, contact Gateway Foundation, one of the most respected addiction treatment centers in the nation.