PARITY FOR SUBSTANCE ABUSE TREATMENT IN FLORIDA
It is hard to read the news without seeing reference to the opioid epidemic in Florida. The prevalence of substance use disorder in our state has many ramifications, not least of which is a widespread need for treatment. When people suffer from a substance use disorder, though, they sometimes find that their health insurance refuses to help.
Substance use disorder (SUD) is one of many mental health disorders for which insurance plans are supposed to provide treatment. SUD is a chronic condition affecting the brain, and patients benefit from long-term treatment. When insurance companies try to force patients to accept only acute, short-term treatment, they leave those patients without their most effective chance at recovery.
In the last ten years, the United States has seen a push for greater parity between the way insurers pay for substance abuse treatment and other medical treatment. “Parity” simply means that insurers should provide the same kind of benefits to patients facing SUD as they do for patients dealing with a major surgery, chronic disease, or any other long-term health condition. The federal government has recognized the need for parity by passing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Even though this law has been on the books for ten years, insurance plans have continued to fight against covering inpatient addiction treatment, even where they routinely agree to cover inpatient treatment for other medical conditions. The United States Court of Appeals for the Ninth Circuit recently ruled that this practice violated federal law. Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (2018). (The opinion is available here: http://cdn.ca9.uscourts.gov/datastore/opinions/2018/06/06/16-35609.pdf)
There was no question that the insurance plan in the Danny P. case was subject to the federal Parity Act. Other insurance companies may escape regulation under that act because of the lack of state laws requiring parity. The Florida legislature had a proposed bill on this subject - https://www.flsenate.gov/Session/Bill/2018/955/BillText/Filed/PDF - but it died in committee earlier this year.
There is already an unfair stigma associated with SUD. People suffering from this disorder need medical help instead of society’s judgment. Insurance companies only contribute to the problem when they deny the coverage that federal law requires. Additional state laws will help, but it may be that patients themselves will have to bring insurance companies to court before they live up to their obligations.
By Jeff Mansell