Tuesday, January 27, 2009

One thing wrong with our health care/insurance system

It's no secret that a major sore spot with me is how people who suffer from depression or addiction are often treated by other (so called) "normal" people or by our health care/insurance system. I wish depression and addiction didn't carry the stigma that they do. It's incredibly unfair when people who suffer from these diseases--and they are diseases--are screwed over.

Case in point: My wife and I checked our son into a rehab program at Brighton (Michigan) Hospital in September to help him overcome an addiction to heroin. Brighton was recommended to us by our son's therapist, and it has a great reputation. So taking him there was a no-brainer. In addition, my health insurance company considers Brighton an in-network facility. What could be better?

Well, as often is the case with insurance-related matters, things quickly deteriorated when we were ready to have our son admitted. After calling my insurance company to check coverage, Brighton told me that my son's stay may not be totally covered. This was a bit of a shock, but it didn't stop my wife and me from checking our son into Brighton. If your child desperately needs help, and you have a world-class "in-network" facility at your disposal, you go with it and worry about the financial matters later. Getting help for your child is your main concern. So when the hospital required me to pay upfront--just in case--I gladly got my Visa card out.

To make a long story short, when our son was discharged after two weeks in Brighton Hospital, we were told that my insurance company was not covering his treatment. At all. The reason the insurance company gave for not paying? Brighton is not a "traditional" hospital, but rather a "residential facility"; and under my employer's policy, treatment at a residential facility is not covered. Of course, I wondered why Brighton was not considered a traditional hospital. I mean, they have doctors and nurses and everything a traditional hospital has. Was I missing something? Indeed, I was. Because in addition to those "traditional hospital" things, Brighton has two other things that are the kiss of death when it comes to insurance coverage: educational and recreational programs.

How sad is it that an insurance company will deny coverage because an addiction treatment facility offers its patients an educational program as part of their recovery, to help them learn about why they have this disease? Are you kidding me?!? And shame on Brighton for providing a pool table, ping-pong table, and a horseshoe pit to help alleviate patients' boredom. What the hell were they thinking??? (Note: Many doctors who specialize in treating addiction will tell you that there's nothing worse than a bored addict.)

This whole scenario is almost as ridiculous as the one that took place last spring, when my wife and I took my son to a rehab facility in Sault Ste. Marie, Michigan, to help him with his increased use of marijuana. The insurance company didn't pay for that, either. The reason: "Marijuana isn't physically addictive, only psychologically addictive." I actually asked a customer service rep at my insurance company about this one. "You mean to tell me that because my son has a problem with marijuana, his treatment isn't covered? But if he had a problem with crack cocaine, his treatment would be covered?" Amazingly, the answer to that question was, "Yes."

The bottom line is that most health insurance companies' coverage for treatment of chemical dependency is a total joke. Having a family member who is addicted to drugs is a big enough nightmare without having to bend over and take it from your health insurance company, too.

Rest assured that this issue with my insurance company certainly isn't over. Not by a long shot. I plan on appealing their decision and will not give up until I've exhausted all possible options. If it takes a lawyer, I'll get me a lawyer (providing I can find one who will work on a contingency basis). I will not go down without a fight. That you can be sure of.

Sending your kid to rehab the first time: $3,000.00
Sending your kid to rehab the second time: $12,155.00
The fact that your kid is still alive, in spite of your insurance company: Priceless

1 comment:

  1. Good for you Dean! I am extremely disheartened with the insurance companies way of doing business. Extremely. Insurance should not be a for-profit business.