Reckoning with Addiction: Insuring your health

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By John Inscore Essick

Towards the end of each calendar year my wife and I sit down to assess our health insurance options for the upcoming year.
As a cancer survivor with no employer-based health insurance option, the Affordable Care Act, often called Obamacare, has made health insurance both possible and relatively affordable for my family. But simply having health insurance doesn’t solve everything.
Each November, we try to find that elusive sweet spot between an affordable monthly premium and a manageable annual deductible. We take into account co-pay amounts for family doctor and specialist visits, prescription drug costs, coverage details for emergency room visits and costs associated with out-of-network providers.
Given all these considerations, deciding on the right balance has always been for us an especially tricky gamble since we can’t predict what kind of health emergencies our family might face in the coming year.
One aspect of our health insurance we have not paid close attention to, however, is what the health plans available to us provide in the way of treatment for substance abuse and addiction. For a number of reasons, substance abuse and addiction have not to this point figured into our annual deliberations regarding potential health risks. That is changing.
Since 2010, commercial healthcare plans have been required to provide addiction treatment as an essential benefit. This mandate has been a lifeline for many, while there are others who would like to see this mandate revoked. I never examined this coverage in my insurance until recently when I called our health insurance provider. I was curious about our benefits and how I would go about accessing them in the event that someone in my household should need professional help with substance abuse or addiction.
The conversation lasted no more than fifteen minutes. In that quarter hour, I learned the in-network names and phone numbers of the nearest mental health specialist, behavioral addiction treatment specialist and residential addiction treatment facility.
I was disappointed, but not surprised, to learn that all these caregivers were at least 50 miles away and that my access to them had unspecified “limitations” and required “prior authorization.” I was unable to determine exactly what the limitations were or what prior authorization would involve or how long it might take. This frustrated me, but I felt more informed and prepared to act if required.
In addition, our family’s relatively high deductible — last year, we opted for a middle of the road monthly premium — would mean that our out-of-pocket costs would rise into the thousands before our health insurance provider begins paying most of the costs.
“This is no different than cancer or any other health problem,” I thought to myself as the representative was talking.
Health insurance has certainly been necessary and helpful for my family, but I was reminded once more of how insufficient it could turn out to be. Then again, not all health insurance plans are created equal.
For help thinking a little more broadly about addiction and health insurance, I reached out to Joan Miles of Henry County’s COMPASS program.
Miles works daily with clients who are seeking help with substance abuse, and most of them have no health insurance and are not enrolled in Medicaid. Some do have health insurance, though.
Miles reports that in her experience the treatment health insurance providers will pay for is quite often “very short term,” meaning that treatment is shortened or clients are discharged after only 30 days.
Moreover, COMPASS clients can find themselves in a situation where a claim is cyclically submitted—denied—appealed. This process can be even more complicated when a Casey’s Law petition is granted. (Casey’s Law makes it possible for an individual to be placed in treatment involuntarily.)
Reticence on the part of my health insurance provider may or may not be an issue should I file a substance abuse treatment claim, but how would I know until I am in the midst of a crisis?
I can only imagine how difficult it must be to navigate insurance coverage while simultaneously struggling with substance abuse or addiction within a family. With health insurance, as many know, it can be difficult to get what you pay for.
These complexities are part of the reason COMPASS works hard to locate and navigate “non-insurance options” like the support group Celebrate Recovery in Henry County or the residential recovery program at The Healing Place in Louisville.
In conclusion, I urge my fellow Henry Countians to examine their health insurance policies from the substance abuse and addiction perspective.
I also urge us all, regardless of whether we have health insurance or not, to research the non-insurance options available to everyone. Because we can’t predict the future, let us begin learning today the names and numbers of those specialists, treatment centers and support groups we hope to never need.

Rev. Dr. John Inscore Essick is co-pastor of Port Royal Baptist Church and associate professor of Church History at Baptist Seminary of Kentucky in Georgetown. Feedback is welcomed by e-mailing hopeinhenry@gmail.com. He also welcomes conversation with those willing to share their stories.