Health Insurance Companies Say No To Allowing Addiction Treatment Professionals To Manage Care In NJ

SEABROOK, N.J., Feb. 19, 2015 /PRNewswire-USNewswire/ -- On Feb. 9, Seabrook House representatives traveled to Trenton, NJ, to support bill S2180 as it was presented to the New Jersey Senate Commerce Committee. The bill would require certain health benefits plans to provide behavioral health coverage, including addiction treatment, without utilization management review, for services deemed medically necessary by licensed professionals like physicians, psychologists, social workers, and advanced practice nurses. This bill would make access easier for those suffering with behavioral health disorders.

Among the Seabrook House representatives in attendance was Vice President of Business Operations, Matthew Wolf. Due to his own long-term recovery and 26 years of experience working in the addiction treatment field, he provided a testimony in favor of the bill to the committee, on behalf of Seabrook House. Testifying against the bill was Mark Friedlander, MD, MBA, the Chief Medical Officer for Aetna Behavioral Health, B. Steven Bentsen, MD, MBA, DFAPA, Medical Director ValueOptions, Inc. and Sarah Adelman,Vice President, New Jersey Association of Health Plans. 

Wolf provided the NJ Senate Commerce Committee with facts and statistics on how many people are denied treatment because insurance companies will not authorize the care as prescribed by Seabrook House treatment professionals. "As many as 25 percent of patients seeking help are denied authorization," said Wolf. "Insurance companies claim the patients 'do not meet our medical necessity criteria.'" However, our physician, who is board certified in addiction medicine, is the treating professional that should be managing the care. Wolf asked the committee to consider why or how these denials are possible. 

Wolf points out that according to the American Society of Addiction Medicine, a substance use disorder is defined as a bio-psycho-social-spiritual chronic disease, but insurance companies are basing coverage only on the bio portion. In many instances, they say if a patient is medically stable, they do not need treatment at a residential or partial hospital level of care.

Adelman testified that "eliminating utilization management creates a blank check [for providers]" Friedlander testified "I am not paid to limit care". Bentsen stated "We are pushing medication-assisted treatment (MAT) and all denials have good rationales."  "We approve the least restrictive and most cost effective levels of care."

Friedlander went on to describe how today's medications are a much cheaper alternative and that in fact, with Aetna's buying power for generic medications, providers should be using them because they are cheaper. Patients must do a trial and error to find the right medication and dose.  If generics fail, then maybe move them to brand name medications.

Also in attendance to support the bill was Mishael Azam, Esq., COO of the Medical Society of New Jersey (MSNJ) and Michael Shore, MD, Medical Director of MSNJ and an addiction psychiatrist. Shore testified to the committee that the insurance companies prolong the process of getting a patient help, and that it is sadistic to not treat them immediately. He stated there should be no barriers to treatment.

A social worker, Philip Young, in practice for 40 years, added that social workers or other health care professionals should be able to submit a treatment plan to an insurance agency without having to get approval. He shares that this patient information is very sensitive, and not all patients want others looking over personal notes and files.

Bill S2180 passed the NJ Senate Commerce Committee with a vote of 4-2. It will continue on in the legal process and hopefully one day be enacted into law.

Seabrook House is an internationally recognized private CARF-accredited, inpatient alcohol and drug rehabilitation treatment center with locations in Bridgeton, NJ, Cherry Hill, NJ, Northfield, NJ, Morristown, NJ, and Westfield, PA. Founded by Jerry and Peg Diehl in 1974, Seabrook House has been helping families find the courage to recover from alcoholism and drug addiction for over 40 years. For more information on Seabrook House, visit our website at www.SeabrookHouse.org.

Photo - http://photos.prnewswire.com/prnh/20150219/176598 

SOURCE Seabrook House

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