When health insurers make it harder for addicts to get treatment, government should act


Gov. Scott Walker has signed about 30 laws designed to address Wisconsin’s opioid crisis as part of the Heroin, Opiate Prevention and Education (HOPE) Agenda.

These include initiatives to give immunity to people who contact authorities to help someone suffering an overdose, the development of a robust prescription drug monitoring program and increased state reimbursement for outpatient mental health and substance use disorder treatment. 

Even so, Milwaukee County’s drug overdose rate was almost triple its homicide rate last year, which argues for continuing to aggressively fight this horrible scourge.

One area that needs more scrutiny: health insurance practices that impede treatment.

Insurers can limit substance abuse treatment by requiring unnecessary medical authorizations, establishing arbitrary clinical treatment guidelines, placing quotas on urine drug screens and setting inadequate reimbursement rates to substance abuse health providers. The Federal Mental Health and Addiction Parity Act ends discrimination in treatment and requires equity and more substance abuse provider participation, on par with existing medical and surgical benefits. 

A December 2017 report by the actuarial firm Milliman Inc. that independently analyzed the insurance claims of 42 million Americans paints a stark picture of restricted access to mental health and substance abuse treatment. Milliman identified a pattern of behavior by insurance companies that forces patients to use costly out-of-network substance abuse care. Milliman points to potential violations of federal and state parity laws, as does another study by economist Dr. Tami Mark, a nationally known health economist. Her study reviewed the claims of 30 million patients and found that insurers are strategically undermining parity by offering lower pay to mental health and substance abuse psychiatrists compared with medical doctors for the same services.

100318-opioids-deaths_Online (Photo: USA TODAY)

These actions ultimately restrict access to care at a time when the epidemic is claiming the life of a Wisconsin resident every eight hours.

The Substance Abuse and Mental Health Services Administration — at the direction of the Trump Administration — has reinforced the importance of evidence-based treatment for opioid addiction, such as Medication Assisted Treatment (MAT). MAT has been scientifically proven to reduce the cycle of cravings, use and possible overdose with opioids. Innovative treatments, such as oral or injectable buprenorphine and others such as Vivitrol and Methadone, have all been proven effective in reducing illicit opioid use and overdose risk.

But too few providers offer these services, despite the growing need, and insurers do little to encourage their participation in network plans. As a prescriber on our front lines and a MAT educator for more than a decade, I have seen MAT’s dramatic improvements in patients’ lives, a substantial reduction of overdose deaths and the reintegration of my patients into society as fully functioning taxpayers.

Governor Walker should refocus the opioid agenda to address the lack of substance abuse parity with health insurers as a means of driving greater access to care. Wisconsin’s Office of the Commissioner of Insurance should investigate parity violations and resolve them. And Attorney General Brad Schimel should devote more resources to enforcing health insurer parity. Over the past several years, New York’s attorney general reached settlements with several health insurers for wrongly denying coverage for mental health issues and drug treatment, resulting in millions of dollars in fines and important changes to their discriminatory practices.

Yes, Wisconsin has taken important steps to mitigate the opioid epidemic. But the most effective path out of this crisis is access to evidence-based treatments — on demand — coupled with enforcement of health insurance parity laws so patients can easily get care. Providers need to be empowered to treat patients and be assured they are not hamstrung by discriminatory and illegal insurance practices that limit access and reimbursement.  

Selahattin Kurter is executive director West Grove Clinic, Milwaukee, and is board certified in addiction medicine, as well as President of Spectrum Healthcare based in Oak Creek, WI


It’s time to dispel the rumors…

“This only happens to young people” – Drug use is increasing among people in their fifties and early sixties.  This increase is, in part, due to the aging of the baby boomers, whose rates of illicit drug use have historically been higher than those of previous generations. – National Institute on Drug Abuse

“This only happens to poor people” – An NBC news segment featured a young heroin addict who was the son of two doctors who themselves treat drug abusers.  Isn’t this proof of the non-discriminating nature of drug addiction? – NBC Nightly News Feature (April 7, 2016)

“This won’t happen if I just smoke marijuana” – One addiction can lead to other addictions, and one drug can make you relapse on another drug.  That’s one of the consequences of a brain that’s wired for addiction.  Suppose you’re addicted to cocaine.  If you want to stop using cocaine, then you have to stop using all addictive drugs including alcohol and marijuana.  You may never have had a problem with either of them, but if you continue to use alcohol or marijuana, even casually, they’ll eventually lead you back to your drug of choice.  Recovery requires total abstinence. – AddictionandRecovery.org

When you drink and/or use drugs on a regular basis, you are susceptible to addiction.  When you take the same amount each time, there will come a time when your body won’t respond the same way.  It likes what it is receiving and will soon want more.  The solution:  Take more!

And so the cycle begins.  The more you take, the more you need, and soon you find yourself unable to function without alcohol or drugs.

What’s next?

The vast majority of people who try to stop using on their own will fail.  It will also seriously upset your body.  Withdrawing has some very unpleasant side effects. In your mind you may be ready, but the dependency is far greater.  Feelings of “it isn’t worth it” overtake you and the cycle of addiction returns.

But there is hope and there is help, and we are here to provide it.

Spectrum Healthcare has been a leader in the fight against addictions for the past decade.  Our clinic currently has five physicians to help you navigate through the addiction process.  We also offer AODA counseling for not only the patient, but the family as well.  We recognize this disease doesn’t just affect the addict, but their family as well.