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Frank Jones and I co-wrote this article between May and June of this year. We found that it was far too long for a newspaper op-ed and that treatment professional magazines did not want to print this. The insurance industry is powerful, as they buy a lot of advertising and contribute to thousands of politicians on both sides of the aisle on both the federal and state levels.

I expect that this article will hurt my consulting business a little, but the moral and social imperatives demand that this issue be properly addressed.

For over a decade, both of source have seen many insurance companies deny payment for addiction treatment services one of us is a licensed clinical social worker, while the other operates a boutique insurance agency to hundreds of individuals. The denials by insurance companies to pay for opiate detoxification, in-patient addiction treatment or intensive outpatient counseling have increased in the last few years, even as more and more people are abusing opiates, overdosing and dying.

It stipulated that insurance companies must pay for mental health treatment in the same way that they would pay for physical health treatment Kevin Sabet states that it took Congress decades to take the radical position that the brain is part of the body.

The law was rife with exceptions and carve outs and was ultimately quite toothless. Inthe Mental Health and Addiction Parity Act was casino online spielen 14 and it attempted casino online spielen 14 fix a number of faults in the law, as well as provide equal coverage for addiction treatment this linked article notes casino online spielen 14 the MHPAEA did not mandate mental health or substance use treatment, but if treatment for these conditions is included as a benefit, plans have to provide it under the same terms and conditions as other medical treatment.

Inthe Affordable Care Act improved upon the law by directing that all insurance plans cover mental health and addiction treatment.

Despite all of these laws and the vast amount click at this page media attention that is now paid to the heroin epidemic casino online spielen 14 the rich and famous people that are dying, insurance companies are still often denying addiction treatment.

This urges the key question: The answer is horrifying: In the rare cases where insurance carriers have been found to be in violation, they have not been fined.

They have just had to pay for the appropriate level of care. This is the epitome of a toothless law and weak enforcement. It was tough and required the family to scramble, but the alternative was grave.

His son stayed clean for a bit, but he relapsed and quickly casino online spielen 14 using 25 bags of heroin a day. It seems that this assertion from those esteemed bodies has not made its way to the insurance carriers who apply coverage limitations to addiction and mental health treatment modalities, which are not applied to treatment modalities tied to physical or casino online spielen 14 disease categories. Increasingly, carriers are lowering reimbursement and shortening the benefit periods for casino tropez android those afflicted with addiction and in need of recovery treatment.

Unrealistic demands are made on the treatment centers, such as the requirement that progress must be demonstrated within three days of admission, or further coverage click here be denied. A person so afflicted for years, prior to finally seeking treatment, is highly unlikely to progress in just three days. As an example, some carriers will allow for 12 days of outpatient coverage with no casino online spielen 14 for in-patient treatment.

It is quite clear that people with opiate addictions have better outcomes with a full continuity of care: Several years ago, real blackjack online games days was allowed for in-patient addiction recovery treatment and five days per week for intensive outpatient treatment. Like oncologists who are far more equipped to diagnose and treat cancer than insurance carriers, diagnosing and treatment for those in addiction should be more influenced by the treating clinicians.

Instead, the physicians and therapists that are employed by insurance carriers have a much stronger role in determining what level of care or if any a patient gets this is almost always done sight unseen; the professional employed by the insurance company reviews a file and only occasionally talks on the phone with a patient. This raises a second question: These claims we are leveling against insurance carriers are not new.

Nor is http://shannononeill.info/fun-casino-wiltshire.php the first article casino online spielen 14 details the insurance denial disaster.

Unfortunately, this vague wording and loose criteria are taken from a medical professional organization and is legal for the insurance companies to use in this way. She wrote about her experience:. He was using alcohol, marijuana and heroin. We tried to get him to source go to treatment. He refused and eventually ended up in Union County Casino online spielen 14. He agreed to go to a treatment facility, but insurance at the time would only approve IOP but through some grace of God he was able to live at a facility in Florida and it was only considered IOP through insurance — the Florida Model.

That was the first of many rehabs my son attended, along with many detoxes and halfway houses. He was considered to be dually diagnosed with this web page illness as well.

Over the course of his fight with this chronic medical illness and he was denied treatment too many times for me to remember. There were also times where his treatment was cut short and I gladly paid out of pocket for his care.

His fight ended on May 27,when he died from this chronic medical illness. Many treatment programs are not getting paid by the insurance companies that had previously agreed to pay for the treatment. The purpose of the audits is to uncover fraud, waste and abuse, the audits aim to ensure that payments are made correctly the first time and to identify, investigate, and recoup payments made in error. Ostensibly, it casino online spielen 14 a program which will save millions, and potentially, billions of dollars.

In reality, it is a program heavily dependent on the use of intimidation and strong-arm tactics to achieve much of that savings. It is a bad policy and terrible ethical position.

We have hundreds of stories about insurance denials just in NJ though there has not been much data collection on a statewide or national basis on insurance denial disaster. Another harrowing tale is casino online spielen 14 a woman who asked to remain anonymous. The insurance company website was of little to no use in trying to find treatment.

I learned of an addiction doctor in Merchantville, NJ Dr. Lance Gooberman who provided an opiate inhibitor. In addition I tried to find counseling for my son. The counselor told us he needed inpatient care or he would die. Our first try to get Z into a rehab was in July He was denied but given approval for outpatient treatment. Z was told verbally that the insurance was denying. I do casino venlo optreden know if he ever received written confirmation of this.

In September, he hit bottom and once again tried to enter an inpatient facility. Since it was a Saturday, the facility could not get in touch with our insurance. By Monday, he was denied, and Livengrin went through the appeal process 3 times.

All were denied and Z returned home on September He returned to Dr. Неужели spielautomaten leasen von трое for Vivitrol injections. He casino online spielen 14 clean for 3 months.

On December 27,I found him dead at home in his music studio. The detective told me he found 2 bags from heroin. Legislation to address these issues is imperative, as it would have casino online spielen 14 profound effect on the outcome of casino online spielen 14 for millions of Americans 1 battling this chronic medical illness 6.

We urge you to consider advocating for and supporting legislation to respond to these national needs.

We are currently working with members of Congress to introduce such casino online spielen 14, and we hope to attract the attention of the White House. Address the adverse determinations by insurers. The systematic coverage denial position the hired carrier physicians take result in prohibiting necessary care to the patients. A bill to address and correct this practice should permit decisions of continued or extended care be deferred to the judgment of the treating physician.

This would almost certainly have a positive effect on treatment, as long-term addiction treatment provides overwhelmingly better outcomes for this chronic medical illness. Similar legislation has passed in Casino online spielen 14 and Pennsylvania, but it is greatly needed nationwide. There must be limitations and mutually beneficial regulation of the billing audit process, of the strong-arm practices of the contractors and http://shannononeill.info/emerald-casino-self-catering-accommodation.php at-will financial hostage situations created by the carriers and audit contractors.

Last week in New York, Governor Cuomo and the NY legislature announced bi-partisan legislation that begins to address some of these problems. The first review by the insurance companies can only take place after 14 days of treatment as we have already discussed, reviews currently happen after 2 or 3 days.

Our final story involves Valerie and her family. She has been a NJ public school teacher for many years. Her youngest son has been in and out of treatment programs for most of the last decade. And yes, going to work every day. As we went through the letters of denial we wondered whether they were actually referring to our sons or their history at all. Yet, our insurance determined them to be adults which meant they had to meet all 6 dimensions.

Valerie has organized a large number of these families into a group and they are hoping to effect an investigation on the state level. They are also advocating for insurance reform through legislation.

Now, Valerie has waterloo casino up the mantle in an equally important fight in our time. We have a health crisis in the United States which is not being adequately addressed, despite the soundbites uttered by politicians and the constant media attention. We need addiction to be recognized and regarded by the carriers as the chronic medical illness that it is.

We need mental health and substance disorder clinicians to have the same role in defining treatment for their patients as medical doctors have in defining treatment for their patients with physical illness. Most significantly, substantive penalties need to be put in place in order to ensure compliance with the existing laws that mandate coverage.

The costs associated with inactivity on this critical point are both high and disastrous. Advocates, professionals, politicians and even private citizens have both a vested interest casino online spielen 14 an casinos near orlando florida to push for insurance reform.

Frank JonesPartner, Mints Insurance — a 20 year insurance leader who advocates for the medical industry and a government affairs professional. He operates a national boutique insurance agency with a focus on medical risks, and a special niche in mental and read article health operations and medical malpractice.

He can be reached at Frank mintsinsurance. He writes a blog at greenagel. He conducts trainings and delivers casino online spielen 14 speeches around the country. He completed a Master in Public Affairs and Politics in In10 years after he was granted an honorable discharge, Frank was directly commissioned into the Pennsylvania Army National Guard as a First Lieutenant.


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