Can't Get Treatment Through Your Health Insurance Plan?

by Deborah Beck, M.S.W.

1. Check your coverage for addiction treatment in your employee benefit handbook. Ask your employer for help, if appropriate. Your employer can override the decision of the health plan or managed care firm.
2. Ask for the assistance of the state insurance department, health department and Office of the Attorney General. Speak up! These state offices are responsible for enforcing the addiction treatment laws but can't act unless they know there is a problem.
3. Ask your local, state legislator to intervene. Legislators appropriate funding to the state offices listed above and expect laws they pass to be enforced.
4. Ask addiction treatment facilities for help while you fight the health plan.
They know how to access limited, alternative funding provided by the state and charity care is sometimes available. If you are serious about challenging the insurer and follow through on the challenge, the treatment program will usually stand by you. Use treatment facilities that will help you. Programs that will start treatment immediately - while you challenge the health plan - understand the seriousness of the illness.
5. Document all interactions with the health plan and keep copies of all materials and correspondence.