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The Real Deal: Insurance coverage for heroin addiction

Updated: Tuesday, May 6 2014, 05:26 PM EDT
ALBANY—The number of people dying from heroin overdoses in New York has doubled in the past five years.  Treatment centers, both impatient and outpatient are packed with addicts trying to get clean.  A number of local families tell CBS6 that getting insurance coverage for that treatment is challenging and in some cases the process was so full of red tape, addicts just gave up. 

The Wasson family of Colombia County has dealt with addiction for years.  Bob Wasson Jr. started using marijuana years ago and then transitioned to heroin.  His family says Wasson Jr. tired a number of times to get into an impatient treatment center but his insurance company would not approve the coverage.  "He was very athletic, he grew up in Maine, outdoors all the time," says Bob Wasson Sr. of his son.  Wasson Jr. was a father himself when he got hooked on heroin, "I sat him down with my wife and I told him, you keep this up, it's a death sentence because that's the only way it ends that I know of," Wasson Sr. says but his son overdosed three times," he just kept telling me, I can't be a good dad cause I don't want to be around my kids in case," Wasson Sr. recalls.

Wasson says his son was denied in-patient treatment at least three times during his fight to get clean, "after one overdose he was admitted someplace down in Kingston and his insurance even said then, they sent him a note after that, that they didn't approve it, and it like a four day stay… They would only cover outpatient treatment which for a heroin user is absurd," Wasson says. 

On a Tuesday afternoon, Wasson Jr.'s girlfriend and children found him dead on the kitchen floor, he was 33 years old.  "If a doctor who has had years and years of training states that there should be certain treatment, who are insurance companies to re-diagnose, it doesn't make sense to me," Wasson Sr. says.

Paul Macielak is the CEO of The New York State Health Plan Association which advocates on behalf of insurance companies.  "The evidence shows that for most cases of heroin addiction, the best course of treatment is on an out-patient basis, not an impatient basis," Macielak says.   Over the last few years, insurers have expanded coverage but the focus, Macielak says, has to be on what's proven to work, "as many as 25-30% of people have had 5 or more admissions already for heroin addiction and treatment so for those people, you really need to start looking at different treatment modalities."  More specifically, the need for medication in overcoming addiction, "for a lot of people, families when you say methadone, it comes with a stigma, and people don't want to have their child become a methadone user yet the evidence would suggest they have a better success rate," he says.
The Real Deal: Insurance coverage for heroin addiction


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