According to treatment advocates, the practice of refusing coverage is widespread even though it's against the law. Under Pennsylvania law, insurance companies must provide 30 days of inpatient rehabilitation treatment per year, with a cap of 90 days per lifetime.

"They're breaking the law because Pennsylvania Act 106 of 1989 says any person in the state of Pennsylvania should be insured for addiction," said treatment advocate Karen Plavan.

Ken Ramsey of Gateway Rehabilitation Institute said that even if insurance companies fund the treatment, it's only for six days. "That law is pretty much ignored in Pennsylvania," he said. "We have to have enough time to make recovery work -- to make a dent in the lives of folks who are addicted to heroin, alcohol or whatever. We just aren't given enough time."

Insurance companies claim that they are not required to give all addicted individuals residential treatment. "Current medical research supports the idea that effective [addiction] treatment can be provided by a wide variety of settings including outpatient, partial hospitalization, and inpatient programs," said a joint statement from Highmark, a primary insurer and Magellan Behavioral Health, the largest third-party mental healthcare administrator in the state.

Pennsylvania Attorney General Mike Fisher is considering punitive action against insurance companies that deny residential treatment. Among the options are levying stiff fines or prohibiting insurance companies from doing business in the state.

"There's a lot of legal nitpicking that they've engaged in in trying to defend their actions; but for the 17-year-old high school student who's become addicted to heroin -- who needs to have that help -- that student and their parents can't afford to have a lengthy dispute as to whether treatment is medically necessary," said Fisher.

Editor's note: Karen Plavan, quoted above, is a member of the Pittsburgh Demand Treatment! leadership team.

COMMENTS ON THIS ARTICLE:

SUBMIT A COMMENT:

Submissions are held for review and approval.
Please read the guidelines before posting.

Name:
Comment: (limit 250 words)
Enter this word (help):	Change

Guidelines for comments