Addiction Treatment: When Insurance Is Not Enough

Many people suffering with alcohol and drug addiction do well once they receive addiction treatment; their outcomes are comparable to those with other incurable chronic diseases, such as diabetes. One of the barriers to treatment, however, is obtaining the money to fund it. Much of the focus has been on people who require public support for medical treatment. In fact, over 75 percent of people with substance use disorders have jobs, giving them access to private, commercial health insurance. Even so, many struggle with deductibles, co-payments, and other limitations in benefits.

Over time, limitations on insurance coverage have taken different forms. Thirty years ago, the initial restrictions were caps on the number of sessions allowed or dollars charged. This restricted the follow-up care that is so essential to effective addiction treatment. Although the caps have been removed, the Affordable Care Act has resulted in large deductibles that can make the initial access to treatment more difficult. Sometimes deductibles exceed the cost of the entire program, forcing patients to make out of pocket payments that are equivalent to having no insurance coverage.

The Kolmac Foundation was founded to assist people with insurance coverage that could help them begin addiction treatment but was not sufficient for them to complete it. The initial funds for the Foundation were bequeathed in the will of Joanne, a grateful patient who had recovered at Kolmac. During her time there, she was upset that the financial struggles of her fellow patients were interfering with their efforts to obtain the treatment they needed. The noted psychiatrist, Dr. Robert DuPont, who treated Joanne, became the first President of the Foundation.

The Foundation celebrated its tenth anniversary this week, having raised almost $600,000 in support of more than 500 patients. Contributions have come in small donations from former patients, and in larger ones from other charitable organizations. Former patients, as well as members of the outside community, make up the board. All serve without compensation. One of the current board members was the initial Foundation recipient. Donations to the Foundation are tax-deductible.

In the meantime, CareFirst, the regional Blue Cross plan, is trying to lower the barriers to addiction treatment with an innovative program to reduce or eliminate high deductibles. My hope is that other insurance companies will adopt the same approach.