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Calif. providers decry restrictive insurance requirements

November 16, 2011
by Gary A. Enos, Editor
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A newly formed coalition of addiction treatment providers in California is looking eastward for a model strategy to address what it considers to be unfair barriers to treatment imposed by the state’s health insurers.

The executive vice president and general counsel of the California Treatment Advocacy Foundation says it is conceivable that the group will work with state legislators to introduce a consumer-friendly addiction treatment coverage bill similar to Pennsylvania’s longstanding Act 106 law. Phillip Greer, a Newport Beach attorney, says the new group already has had some discussions with leaders of Pennsylvania’s addiction treatment community who have been successful in advocating comprehensive treatment in that state.

“The insurance companies in California have created barriers to treatment, especially to treatment envisioned in the federal parity law,” says Greer. The California Treatment Advocacy Foundation was launched in September and has about 20 participating member providers at this point, he says.

A newly launched dialogue within the Addiction Professionals group on LinkedIn reports on a recent development of concern in California. Word among providers in the state is that Blue Shield of California recently instituted a revised policy under which it will authorize residential substance abuse treatment only when a serious psychiatric disorder or medical complication is present for the plan member.

A Blue Shield spokesperson offered this written comment on Nov. 17 in response to questions from Addiction Professional: "Blue Shield has not changed our policies concerning coverage for substance abuse treatment. Our policies require only the presence of a serious psychiatric disorder."

Some LinkedIn group members have said they identify with the California providers’ concerns. “I have had cases denied of opioid- or benzo-dependent patients with significant withdrawal who have been denied if they are not actively suicidal or medically in need of serious intervention (e.g., seizing or bleeding, etc.),” writes Mel Pohl, M.D., medical director of the Las Vegas Recovery Center. “Very frustrating for patients to access necessary proper care for addiction.”

However, others in the LinkedIn group have pointed out that residential treatment, while superior to no treatment at all, has not been proven in peer-reviewed research to be more effective than outpatient care, and that less intensive levels of service generally represent a wiser use of finite resources for treatment.

Greer says that while few California insurers dropped substance abuse treatment coverage altogether after the federal parity law’s enactment, many have made subtle changes to their regulations and documentation requirements that in total have resulted in restricted access to treatment.

Greer adds that the new organization already is working with a couple of state legislators in an attempt to have legislation introduced in 2012. He also expects that the coalition will become involved in advocacy on other aspects of addiction services.

None of the existing treatment provider associations in California is formally aligned with the new foundation, though Greer says that the formation of the new group does not reflect dissatisfaction with the advocacy activity of these other groups in the state.