The Pennsylvania Commonwealth Court has ruled that HMOs and group insurance companies must pay for cost of alcohol and drugs treatment for policyholders who have been referred to rehabilitation, detoxification and outpatient programs by a physician or psychologist. This unanimous decision will assist approximately 15,000 residents of the state with private insurances who require help in the process of detoxification and rehabilitation every yearonline server permit class.
A state law of 1989 mandates that insurance companies cover detoxification as well as rehab services. Aetna, Independence Blue Cross and the Insurance Federation of Pennsylvania and other managed-care associations have filed suit against State’s Insurance Department, saying that they are entitled to look over alcohol and drug treatment recommendations to ensure that the treatment is suitable. However, the court agreed with the insurance department’s view that the treatment would be covered so long as a physician or psychologist has prescribed the drug or alcohol rehab program.
“It’s a really important decision,” said Deborah Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania. “Somebody at the end of an 800 number in another state should never be making these decisions.”
The insurance industry can contest the decision of the Pennsylvania Supreme Court and argue that the state law allows insurers to examine treatments in other areas of health before paying for medical care and that it’s sensible that detoxification from alcohol and drugs and rehab programs for drug addiction should be treated in the similar as other programs. The review of the insurance industry’s the referrals to rehab and alcohol will be handled by doctors and psychologists as one Insurance Federation of Pennsylvania spokesman stated, noting that when you aren’t able to scrutinize the treatment practices, you’ll incur more expensive health care expenses.
But, the psychologists and doctors who evaluate cases for insurance companies are compensated by insurers. Even though this fact wasn’t discussed in the context of the ruling of the court but the fact is that the decisions of reviewers could be influenced by their employers which include HMOs and insurance companies rather than addicts, who’s treatment professionals have already decided that they require alcohol or rehabilitation and detox programs.
The battle in battle with HMOs and group insurers over the need for coverage is nothing new for Americans. The subject has been discussed in a variety of films and books that outlined the horrors that result from the industry’s tendency to put their profits before the health of patients.
According to Beck her research, reducing the availability of alcohol or drug rehabilitation through a lengthy approval process puts the addicts in danger. They may “disappear and die,” she claimed, noting that the court’s ruling is the “life-saving” law.
After more than two decades of being in effect after nearly two decades of existence, the Pennsylvania law might finally have the chance to fulfill its goals – getting addicts suffering from substance abuse or addictions to rehab facility for alcohol or drugs in the shortest time possible.