The obstacles of insurance: Getting addiction treatment covered
SALT LAKE CITY (KUTV) — About 15 years ago, Lana Bylund found out four of her eight children were addicted to drugs.
"You try to fix it like you do when they're little kids and you can't. You just go crazy trying to fix it," Bylund said.
They've been in and out of treatment ever since.
"There's been two months in the last 15 years that all three boys were in treatment and my daughter was doing well," said Bylund.
She does whatever she can for her children, but can't put a dollar amount on what she's paid to get them help.
"It's scary," she said. "Even when I think, 'OK, they're getting something really great out of this,' it's terrifying when that next step comes."
Most insurance covers 30 days of treatment — but that's not enough. And it takes time to get them signed up for any type of coverage; but urgency is needed when they're ready for treatment.
They're sick; I see it," Bylund said. "I know my children. I know they wouldn't be out on the street if they were not sick. You know they have a disease."
Once someone gets into treatment, that doesn't mean the obstacles will end. According to Corey Markisich, the executive director of Wasatch Recovery, it's not uncommon for insurance companies to decide not to cover someone after a few days.
"That unfortunately happens a lot," Markisich said.
At Wasatch Recovery, Markisich says if that happens to someone then they still let the client stay for the full 30 days.
"It's just because there's less money out there, there's a lot of people that have taken advantage of the system, and so insurance companies are trying to protect themselves," he said.
Markisich says at Wasatch, they consistently assess clients and work with insurance companies to determine what they'll cover.
Some treatment centers take Medicaid which can cover 365 days a year, but qualifying is based on income. But some in the recovery field believe even with Medicaid expansion, there is still a gap in coverage.
"There are some folks that have a job that pays them well enough that they don't qualify for Medicaid services, but they don't receive insurance coverage through their employer so they're kind of left out of coverage," said Evan Done, development director at USARA.
The people at USARA, or Utah Support Advocates for Recovery Awareness, help people navigate the system of finding addiction treatment. Done, who is in recovery himself, also has seen insurance companies require getting treatment at a lower level of care--like outpatient treatment--before higher levels will be covered.
They're saying in essence, in effect, you need to risk death to get to a residential level of care, which seems like — seems just like insanity, right?" Done said.
Experts say shedding old ideas of treatment and addiction, as well as making insurance more accessible for substance use disorder, won't happen overnight.
2News' Jim Spiewak asked Dr. Adam Gordon, a professor of medicine and psychiatry at the University of Utah, why insurance only covers a certain amount of days when the research shows people need a lot more help than that.
"It's a big problem because the mental health insurance coverage in the United States has generally been time limited," Dr. Gordon answered.
Coverage may be for only a 90-day treatment program or 10 to 12 sessions of counseling.
But Dr. Gordon says insurance companies are beginning to realize that's not enough to help addiction disorders.
"If they can get people into outpatient care, healthcare providers, counselors — they can avoid the every expensive hospitalization and emergency visits," Gordon said. "We're seeing more and more insurance carriers broaden their coverage for patients with addiction."
Gordon says it's up to healthcare professionals to show it's cheaper to be preventative than reactionary.
In short, we need to normalize the disease "and the disease can be taken care of in normal medical settings, then the insurance coverage, the medications will be readily available to anybody," Gordon said.
It's help that Lana Bylund hope happens soon.
They need to be there longer; they need to have the time to work through what's keeping them sick."
If you need help navigating treatment and aren't sure where to start, USARA has peer recovery coaches who can help guide you.
There are also some treatment centers like Odyssey House who will take people who can't afford insurance.
There is a list of resources on the Addicted Utah resource page.
