Friday, November 20, 2015

Anthony's Act and a personal story......

A dear friend who travels this journey with me as a mom of a precious son who also has substance abuse disorder received an awful blow to their son's recovery this past week and its gotten me so riled up. She gave me permission to write about this today.

After being out on the streets for almost a year, living in deep addiction, through a series of events this young man was mandated by the courts into treatment for 6 months. After 60 days, her boy was doing so well. Had gained 50lbs, was HAPPY to be in treatment, grateful....still you could see the marks left from long term addiction on his body and in his thinking, but it was tremendous progress and for the first time in a very long time, the family felt hopeful. We have all shared in their joy. It has been a beautiful transformation.

Until......

The insurance company decided that treatment was no longer "medically necessary" and is now refusing to pay. The family is desperate to keep their son in treatment, and in good treatment....counseling, therapies, learning life skills, so they are frantically piecing together the $10,000 to cover the next 5 weeks until they can get him covered by a private pay insurance policy that will go into effect Jan. 1. This of course will be an incredible financial hardship as it would be for the majority of us.

Getting help for our sick kids should not be this hard.

To me, the only analogy I can think of to describe this situation is...

someone enters into treatment with a physician for deep debilitating depression. They are prescribed an anti-depressant. The treatment begins to work and they begin to feel better...and now the insurance company decides since they feel better, their treatment is no longer medically necessary, and they stop paying for the medication. The patient is JUST GETTING THEIR FEET BACK UNDER THEM. They are not in any financial position to be able to afford to cash pay for their treatment... so once again, they determine to try really hard and hang onto what they have just received. However, the damage done to their brain chemistry has only just begun the very slow process to stabilization. Not surprisingly, it is only a matter of time before they just can't hold it all together anymore and they drift away back into their disease, feeling hopeless and ashamed. It is an infuriating catch-22 that seems to be constructed to keep our kids sick. They begin to heal and do the work and feel some hope and their treatment becomes unattainable for them, unreachable. Penalized for getting well.

It is a broken system and it is so infuriating and sad and heartbreaking that our most loved kids are sick and dying due to a treatable, preventable, disease... because they are being refused long term treatment. There are research studies done that strongly support the idea that long term substance abusers NEED LONG TERM treatment to heal. It can take 3 years for a opioid addicted brain to heal and regenerate. In all actuality, it would save our nation thousands and thousands of dollars to help them heal and be free rather than chronic relapsers.

I would ask that you would please sign the Anthony Act petition which is proposing that an amendment be made to the Affordable Care Act that would require insurance companies to cover a MINIMUM of 90 days of treatment. Heroin addiction affects the whole person physically, mentally, spiritually and emotionally and it needs to be treated wholistically and not as a character weakness which only perpetuates the stigma, the shame, and the hopelessness. If you are so inclined you could also write letters sharing your story and asking for this amendment to be made, to each of your state senators and representatives.

God bless us all as we walk together.....
Annette

8 comments:

Birdie said...

I wish I could sign this but I can't because I am in Canada. It is something I really believe in though!
Do they have a GoFundMe page?

Anonymous said...

I see two culprits here and they are intertwined. First, the cost of effective drug treatment/rehab care should be affordable. $10,000. for 5 weeks is unaffordable for all but the wealthy. There is a clear profit motive here of the rehab industry that makes affording care impossible. Second, the insurances should pay for lengthier and more comprehensive treatment. I'm so sorry that the family and their son are caught in between. It should not be that greed trumps good care and health.

Holly

Annette said...

AMEN Holly!

Syd said...

I agree with Holly that rehabs are ridiculously expensive. Many families use all of their money to help their loved ones. Very sad. Thanks for posting this, Annette. I hope some changes will be made.

mary christine said...

Unfortunately, your depression analogy is spot on. Insurance companies won't pay for treatment. When I was doing utilization review (working with the insurance companies to get them to pay for treatment for patients), they would accuse us of "warehousing" patients after a day or two.

Inpatient care is prohibitively expensive, no matter what the illness. No one can afford it. If the insurance companies started paying for more, most of us would be unable to afford the insurance premiums.

I believe there is always hope for our addicts. After many stints in rehab, many that were lengthy and very expensive, my daughter finally got sober. By herself. It was awful, but she is still sober nearly 7 years later.

Annette said...

And your daughters story gives me so much hope! I tell other parents about her often....no names of course! Lol

Anonymous said...

Even with all the new laws that went into effect in New York State this is still happening here as well. At least now they will cover 30 days in-patient whereas before this would never happen. Unfortunately, you are limited to the rehabs that they will cover, unless you find an out of state rehab which will strong arm the insurance company, I have heard of this working. In my opinion there are two problems here, the cost of in-patient rehab is absolutely ludicrous, this is one of the reasons the insurance companies are not willing to pay for more than a month. Most rehabs are well over $10,000 a month. We need affordable rehabs, I believe that if rehabs did not charge such a ridiculous amount for a month's stay then the insurance companies may be willing to bend a little and pay for a 90 day stay. Addiction isn't the only area where insurance companies are not taking care of their customers, many people have to pay out of pocket for chemo, hearing aids, visits to specialists, the list goes on and on. It really makes me sick, my nephew had to come up with $1,500 to see a neurologist in New York City as the top neurologists cannot seem to come up with a diagnosis for him. The insurance company refused to pay as the top neurologist is out of network. My sister who lives in California has a $10,000.00 deductible before any benefits kick in, this was the best plan they could afford and her 61 year old husband and suffering with serious medical issues. There needs to be so many changes across the board, I'm so tired of hearing about people not being taken care of because of this.

Erin

Liz said...

Annette... SIGNED!