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Families Report Insurance Gap Hinders Opiate Addicts' Chances At Recovery

Campbells.PNG
Tyler's Light
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Tyler Campbell (center) with his parents, Wayne and Christy Campbell. The Campbells began Tyler's Light after Tyler overdosed on heroin in 2011. Tyler's Light raises awareness about opiate addiction.

Beating an opiate addiction is tough. Without treatment, experts say the relapse rate is as high as 90 percent. Treatment is expensive. Costs can swell to tens of thousands of dollars in just a month. There’s an unlikely group of people that seems to be caught in a coverage gap: those with health insurance.

“Just a kind, sweet, sweet child, and as he grew up, he was the same. Kind and sweet and loving.”

Christy and Wayne Campbell remember their son Tyler as a sensitive guy who loved playing sports.

“[He] wouldn’t hurt an animal. Couldn’t go hunting…but then you cut him loose on a football field and it’s holy terror," Wayne Campbell said. 

Tyler Campbell died of a heroin overdose, in 2011. He was 23.

Christy Campbell said her son had just completed a four-week stint in inpatient rehab. It was his third try at recovery, and the longest he had been in treatment. Christy Campbell said she managed to persuade the insurance company to cover two extra weeks, even though she was told it wasn’t “medically necessary.” 

“I cried on the phone to her and begged her, ‘Please do not let my son leave this facility. Please allow him to stay there longer,'" Christy Campbell said.

With good jobs and health insurance, Christy and Wayne Campbell, of Pickerington, thought they were in a good position to help their son get better. But they say two weeks of treatment here and two weeks there didn’t cut it.

“You look back going there was no chance. You had zero chance of making it. Absolutely none." Wayne Campbell said. “That double-income household with private insurance may be the lost group. And that’s probably the majority, too. What do you do with them?”

Addiction treatment facilities we talked with say there are a lot of Christy and Wayne Campbells. 

Dr. Brad Lander leads an opiate addiction therapy group at an Ohio State University treatment facility where he directs Addiction Medicine.

Lander said there's no set treatment plan for opiate addiction. Some patients do well with intensive outpatient treatment, while others need more hospitalization. But getting that covered...

“We still run into the same problems of being denied treatment when we have justification for it.”

Lander said if insured patients had Medicaid, treatment and outcomes would be different. 

“They cover the services that the patient needs, whereas with the insurance companies they have these large deductibles, and, again, there’s different criteria that they use. So I think the middle class is at a disadvantage," Lander said. 

The federal Parity Act was supposed to guarantee mental health coverage was on par with coverage for other health issues. But Lander said he hasn’t seen any improvement. 

Dr. Richard Whitney is the medical director at Shepherd Hill, a treatment facility in Newark. He often finds himself in the same position as the Campbells:  on the phone with insurance company doctors trying to convince them why a patient should stay in treatment a little longer.

"It’s unfortunate that most insurance companies do not treat this as they would cancer, diabetes, arthritis, heart disease, and other chronic, relapsing, treatable, but incurable, diseases," Whitney said. 

But insurance companies we talked with paint a different picture. They say they follow federal laws and provide individualized care.

Dr. Mark Friedlander leads Aetna’s Behavioral Health division. He said Aetna covers all levels of care: detox, inpatient, outpatient treatments.

“It’s medically necessary care based on symptom severity, based on the individual’s rate of progress rather than a fixed length of stay at a particular setting where we say, 'hey, that’s your benefit, use it wisely, that’s all you get,'" Friedlander noted. 

"One size does not fit all when it comes to addiction treatment," said. Dr. David Muzina, of Medical Mutual. 

Muzina said “the coverage is there.” Muzina oversees Medical Mutual’s Behavioral Health. He suggests the sticking point between insurance companies and treatment facilities is what it takes to get someone well.

“There’s no evidence that would say that outcomes are clinically or economically better if you start out with that full Cadillac model, so to speak," he said. 

But Shepherd Hill’s Dr. Whitney disagrees. He said long-term treatment - two to three months - gives patients a better shot at recovery. 

“Then we drive that relapse rate down to the 20 to 30 percent," he said.

The insurance companies noted they are learning more about addiction treatment and they’re doing more. Aetna noted it’s considering after care coaches to act as sponsors for people when they leave treatment.