Pa. Court to Rule on Who Decides Addiction Treatment September 10, 2004
News Summary
The health-insurance industry has filed a lawsuit against Pennsylvania regulators, counties, and prosecutors over who should decide the type of treatment given to addicted individuals, the Associated Press reported Sept. 7.Health maintenance organizations (HMOs) argue that decisions about alcohol and drug treatment should be left up to them, not a patient's doctor or psychologist.
"The issue is who's making the decision and should it be someone who's looking at the patient," said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania.
Currently, the decision-making process varies from insurer to insurer. In recent years, state regulators have been seeing an increase in the number of complaints filed for denial of services and doctors being overruled by insurers.
Last year, the Pennsylvania Insurance Department tried to clarify the issue by saying that only the referral of physicians and psychologists is required for treatment. The decision led to a lawsuit from the insurance industry.
The lawsuit cites a 1998 law governing managed care, which states that HMOs must be allowed to review referrals for alcohol and other drug coverage in the same manner as they do for all other forms of coverage.
A decision from Commonwealth Court judges is not expected for several months.
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