Some Emergency Departments Won’t Test for Alcohol Because of Insurance Issues

Some emergency departments do not test patients’ blood or urine for alcohol because of issues with insurance payments, Kaiser Health News reports. In more than half of states, insurers are allowed to deny payment for medical services related to alcohol or drug use.

Up to 50 percent of people who are treated in hospital emergency departments and trauma centers are under the influence of alcohol, the article notes.

A recent study found people who engage in hazardous and harmful drinking are more likely to reduce their consumption of alcohol for at least one year if they receive just seven minutes of counseling from an emergency room physician. Physician counseling can also reduce drinking and driving.

Screening for alcohol or drug use is not required in emergency departments, according to Kaiser. Level 1 and 2 trauma centers, which can handle patients who have sustained injuries in major accidents, are required to do so. Level 1 trauma centers also must provide counseling.

Many states have laws that allow health insurers to refuse to pay for care, if the patient’s injuries occurred while he or she was under the influence of alcohol; some laws also include drug use. In 2001, the National Association of Insurance Commissioners recommended against these laws. At least 15 states have since repealed or amended their laws in order to ban this practice.

Self-insured companies that pay their employees’ health care costs directly are allowed to refuse to cover claims related to alcohol.

4 Responses to Some Emergency Departments Won’t Test for Alcohol Because of Insurance Issues

  1. Michael W. Shore, M.D. | May 1, 2012 at 2:07 pm

    Not at all surprising – has been a problem for a long time. At least the insurance companies are consistent – they also do not want to pay for medically necessary addiction treatment!~!!!

  2. Charlie Ball | May 1, 2012 at 2:35 pm

    Where can I find a list of those states and insurance companies. This practice impacts not only patient safety, but also as a Substance Abuse Professional for the DOT, public safety.

  3. William Tyrrell | May 2, 2012 at 11:34 am

    What is the defect in the federal “parity” legislation that allows this practice to continue. That legislation was promoted widely as prohibiting discrimination against coverage based on mental or substance abuse diagnoses. Perhaps more importantly, how many insurers use these state laws to actually discriminate; they should be widely communicated so that buyers will understand the limits before they purchase such inadequate coverage. Or is this just another excuse for hospitals to avoid their responsibility.

  4. Rob Fleming | May 15, 2012 at 8:37 am

    In Washington, DC, the DC Recovery Community Alliance successfully worked to overturn the Alcohol Exclusion clause. We did that by pointing out to the insurance lobby the experience of our own members that, because their alcohol abuse was not addressed the first time in the ER, they re-injured themselves and submitted additional claims.

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