Pa. Doctors Have Final Say on Addiction Treatment September 8, 2003
News Summary
The Pennsylvania Insurance Department has issued notice to health insurance companies doing business in the state that physicians, not a managed-care firm, have final determination regarding referrals for inpatient and outpatient treatment services, Alcoholism & Drug Abuse Weekly reported Aug. 25.Treatment providers applauded the state's directive, saying that for too long Pennsylvania residents have been unable to obtain care or have received inadequate alcohol or other drug treatment services because of policies set by managed-care companies.
"We view this as a perfectly accurate reading of the statute," said Deb Beck, president of the Drug & Alcohol Service Providers Organization of Pennsylvania. "It gives the power back to the physician. The right of the treating physician has been upheld and that ought to be the case in every state."
On the other hand, health insurers said the state's statement could have adverse implications to their infrastructure and contractual relationships.
"It really throws managed care out the window as to drug and alcohol treatment benefits," said Jonathan Vipond III, a lawyer who represents Magellan Behavioral Health's interests before the state General Assembly.
State law mandates seven days of detoxification services per year and 30 days of residential rehabilitation per year, with lifetime benefits.
But the law had been interpreted in different ways by providers and managed-care firms. Providers said the law requires the treating physician to authorize treatment, while health insurers maintained that the law doesn't deny them the right to review cases and deny minimum coverage if the criteria are not met.
Related Feature Story:
Read about the role that PRO-ACT and Southeast Pennsylvania Demand Treatment! are playing in ensuring that the state law mandating treatment benefits is enforced.
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