WHITE PLAINS, N.Y. – Having insurance benefits and being able to access them are two very different things for families struggling with substance abuse, Founder of Families In Support of Treatment (FIST) Anthony Rizzuto said at a recent symposium at White Plains High School.
FIST connected families with information on treatment options, signs and symptoms and strategies for drug prevention at the event Thursday, June 12. Then, several speakers shared their expertise and personal experience.
A few days prior, the state Senate passed a bill that would improve the review process for determining insurance coverage for substance abuse treatment, add state oversight to those decisions through a random sample audit of denials, and require insurers to continue to provide coverage throughout the entire appeals process in cases where coverage is denied.
Rizzuto said he is hopeful it will pass the Assembly, but is doubtful that Gov. Andrew Cuomo will sign it.
Nancy Markey understands the need for this legislation. Her son started treatment for substance abuse at the age of 16. They sent him to rehab for 28 days and he wound up staying for 120 days at the recommendation of clinicians. He is now three years sober and attending college
She said her insurance covers that type of treatment, but her claim and subsequent appeal were denied.
Markey then turned to the state appeal process in Connecticut, which she said lasted more than 10 months and took another six to get the insurance company to pay.
“You don’t want to be in the insurance appeal process because if you think that they want to pay your claim or that there’s anything you can tell them that will make them pay the claim, you’re wrong,” she said. “You’ve got to go to the external (state appeal process) because, remember, the whole time that you’re dealing with this you have a child who is sick and in rehab.”
During her appeal process, Markey said she discovered the insurance companies and treatment providers were using different sets of criteria.
Under Senate bill S7662A and Assembly bill A9943A, everyone would have to use the American Society of Addiction Medicine criteria to measure the level of care a person needs.
The bill would also require health plans to use a behavioral health specialist to oversee the medical management decisions relating to substance abuse treatment.