Pubdate: Mon, 07 Apr 2014
Source: News-Item, The (PA)
Page: 5
Copyright: 2014 The News Item
Author: Meghan Barr, Associated Press


Packed Facilities, Expensive Treatment and Insurance Non-Coverage Are

NEW YORK (AP) - As the ranks of heroin users rise, increasing numbers
of addicts are looking for help but are failing to find it-because
there are no beds in packed facilities, treatment is hugely expensive
and insurance companies won't pay for inpatient rehab.

Some users overcome their addictions in spite of the obstacles. But
many, like Salvatore Marchese, struggle and fail. In the course of
Marchese's five-year battle with heroin, the young man from Blackwood,
N.J., was repeatedly denied admission to treatment facilities, often
because his insurance company wouldn't cover the cost. After abusing
marijuana and prescription painkillers as a teenager, Marchese had
turned to heroin for a cheaper high.

Then one night in June 2010, a strung-out, 26-yearold Marchese went to
the emergency room, frantically seeking help. The doctors shook their
heads: Heroin withdrawal is not lifethreatening, they said, and we
can't admit you. Doctors gave him an IV flush to clean out his system,
and sent him home.

Marchese and his sister stayed up all night calling inpatient
treatment centers only to be told: We have no beds. We'll put him on a
waiting list. Call back in two weeks.

As Marchese grew sicker with diarrhea, body aches and shakes, his
sister tried a new tack. She called one more place and told them her
brother was using heroin and also drinking alcohol. That did the
trick, because alcohol withdrawal can cause life-threatening seizures.

He was admitted the next morning, and released 17 days later when his
funding from the county ran out. Less than three months later,
Marchese was found dead of an overdose in his mother's car, a needle
and a bag of heroin on the center console.

"Insurance companies need to understand that this is a disease," said
his mother, Patty DiRenzo. "Heroin is life-threatening, I don't care
what they say. Because we're losing kids every day from it."

Numbers doubling

Of the 23.1 million Americans who needed treatment for drugs or
alcohol in 2012, only 2.5 million people received aid at a specialty
facility, according to the federal Substance Abuse and Mental Health
Services Administration. Heroin addicts are a small slice of overall
users, but their numbers nearly doubled from 2007 to 2012, to 669,000.
At the same time, the number treated for heroin did increase sharply,
from 277,000 to 450,000.

What is at issue is whether they are getting the treatment they need
to successfully beat their habits. Advocates say they are not, partly
because the insurance industry has not come to grips with the dangers
of heroin withdrawal and its aftermath.

It is true that, unlike withdrawal from dependencies on alcohol or
benzodiazepines like Xanax, heroin withdrawal does not kill. But it is
so horrible-users feel like their bones are breaking, they sweat and
get the chills and shakes, and fluids leak from every orifice-that
many are drawn back to the drug, with fatal consequences.

Even if addicts survive withdrawal, they often relapse if they fail to
make it into treatment. That's when many overdoses happen, because
they try to use as much heroin as they did before, and their newly
drug-free bodies can't handle it.

Because withdrawal is not directly deadly, most insurance companies
won't pay for inpatient heroin detoxification or rehab, said Anthony
Rizzuto, a provider relations representative at Seafield Center, a
rehabilitation clinic on Long Island.

They either claim that the addict does not meet the "criteria for
medical necessity"- that inpatient care would be an inappropriate
treatment-or require that the user first try outpatient rehab and
"fail" before he or she can be considered for inpatient.

"Ninety-nine-point-nine percent of the time, we hear 'denied,"'
Rizzuto said. "And then we go to an appeal process. And we get denied

Susan Pisano, a spokeswoman for America's Health Insurance Plans, the
national trade association that represents the health insurance
industry, defended the industry's practices.

"Health insurers rely on evidence-based standards of care that look
at: what is the right level of coverage, the right site of coverage,
the right combination of treatments," she said.

There is a great deal of debate in the addiction world about what is
the best way to get clean, but most authorities agree that inpatient
care is often essential for full-blown addicts- a first, crucial step
in the process.

For the few who do get some insurance coverage, what they're getting
falls short of what they need and often what their policies allow.
While most insurance policies cover up to 30 days in a residential
center, nobody actually gets those 30 days, said Tom McLellan, CEO of
the nonprofit Treatment Research Institute in Philadelphia who served
as deputy drug czar under President Barack Obama.  
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