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Some Insurance Companies Won’t Cover Opioid Abuse Treatment, Addiction Specialist Says

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Some insurance companies deny coverage for opioid abuse treatment, according to an Oklahoma addiction specialist. Dr. Charles Shaw, who has treated more than 100,000 patients for drug and/or alcohol abuse over the past 23 years, says today most of his patients are addicted to opioids. Many of them are young.

He finds it difficult to get insurance companies to agree to cover extended stays in substance abuse treatment programs. This is unfortunate, he says, because longer stays in treatment lead to higher success rates. “There’s no question—the longer you stay the better,” he told NewsOK.com.

He finds insurance companies are more likely to cover alcohol treatment than opioid treatment. If companies do cover opioid treatment, it generally is for only several days, which he says is not enough.

Nicole Amend, a spokeswoman with Blue Cross Blue Shield of Oklahoma, the state’s largest health insurance company, said it covers extended stays in drug treatment centers “when medically necessary.” In a statement, Amend said, “When seeking treatment for an addiction, behavioral health coverage is not dependent on either the member’s age or the type of substance addiction. However, the type of substance and the member’s age may impact the appropriate treatment option available.”

5 Responses to this article

  1. Avatar of Miastella
    Miastella / March 24, 2012 at 11:44 am

    Actually most insurances don’t cover opioid treatment at all. Anything they can get away with not subsidizing. I suppose it doesn’t matter that the prescription opiate treatments they do pay for causes addiction issues which are on the rise. Makes no sense.

  2. Rocky Hill / March 23, 2012 at 3:21 pm

    The most effective and least costly treatment for opioid addictions is buprenorphine. Unfortunately, the inpatient addiction industry is against the use of buprenorphine despite multiple studies showing its efficacy. Is there a link between return stays and their attitudes?

  3. Avatar of William Carrick
    William Carrick / March 23, 2012 at 2:18 pm

    This title is a little misleading. It references “opioid treatment” and then specifically refers to extended stays. The lack of coverage for extended stays has been an issue for years. This is nothing new. It does not behoove our industry to mislead people on this subject.

    Dr. Charles Shaw states “There’s no question the longer you stay the better”, actually there are numerous questions about length of stay in extended stay programs. If extended stay was cost effective, I assure you insurance programs would cover them. However they are not cost effective. The relapse rate is too high for insurance programs to swallow. Dr. Shaw, show me the data!!

  4. Angel / March 19, 2012 at 5:46 pm

    How about making this spokesperson aware of the following:
    NQF Voluntary Consensus Standards of Care
    • Pharmacotherapy
    8. Pharmacotherapy should be recommended
    and available to all adult patients diagnosed
    with opioid dependence and without
    medical contraindications.
    Pharmacotherapy, if prescribed, should be
    provided in addition to and directly linked
    with psychosocial treatment/support.

  5. Michael W. Shore, M.D. / March 19, 2012 at 2:55 pm

    The problem of inadequate inpatient coverage has been a long standing problem. Another worsening trend is the requirement for precertification to prescribe Suboxone in an outpatient setting. This is a time consuming exercise which adversely impacts on the willingness of certified prescribers to treat patients addicted to opiates due to the excessive time burden necessary for many insurance companies or their managed care subsidiaries. It is absolutely a “penny wise, pound foolish” approach by insurance, since the treatment with suboxone on an outpatient basis is multiple times less expensive than the cost of even a 7 day inpatient treatment. I would venture the opinion that the outcomes of this outpatient office based treatment are equal or superior to the short inpatient stays that insurance will currently cover. However, many suboxone certified physicians do not want to deal with the hastle fo these “precerts” and the result are patients unable to find a doctor willing or with the openings to treat them. Dr. Shore

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