What if the insurance companies are right?

By Reya Kost, Psy.D.

According to Fonthill Counseling, “Insurance companies count on your ignorance, laziness and distractibility to avoid paying for services they are legally obligated to cover.”  Any person who has been responsible for getting treatment authorized, or utilization review, will tell you it is like going to battle.  The treatment staff is armed with what they believe is undeniable evidence of their client meeting “medical necessity.”  The insurance caremanager is tasked with finding anyway possible to justify a lower level of care, hence a lower payout, for the insurance providers.  For any veteran of the rehab industry, this is a tale as old as time.  “It’s not enough time.” “How can they expect someone to make it after only a week?”  “They have barely finished detox, how can they be ready for a lower level of care?”

In the last 30 years of research, no conclusion has been made that supports a need for residential treatment.  “A research consensus is developing that states inpatient rehabilitation has no advantages over outpatient treatment and that even hospitalization for detoxification is unnecessary for 90% of patients (Cummings, 1991).”  Of course there is need for medically based detox services for some dependencies or for those with complicating medical conditions, however, it seems as though this is the exception, not the rule.

According to the United Nations Office on Drugs and Crime, Community Based Treatment can encourage behavior change directly in the community rather than in isolation.  The community can also support the person attempting behavioinsurance company denying claimr change by providing a wealth of other resources like job skills, nutritional education, and parenting skills.  There is a growing body of research that supports interpersonal connection, community belonging, and secure attachment as critical to creating lasting change (see Brene Brown, Gabor Mate, and the statistics on Portugal’s decriminalization). It seems as though we can surround those who struggle with substance use as a community and support them through the change rather than isolating and stigmatizing them.  Maybe stabilizing and integrating quickly in the community is the way forward.

Maybe the insurance companies are right.

For an innovative alternative to inpatient addiction treatment, check out our Individualized Intensive Outpatient Program.