Our insurance company refused to cover the long-term treatment my son needed

Even though addiction is a chronic disease, it is often treated with brief, episodic care.

By Nancy O'Brien

Sometimes he had insurance and they would cover it, but they would only cover it for brief periods of time. Sometimes they would cover three or four or five days of treatment, and then they would say, “Well, you know what, we can’t cover him anymore,” and then we would have to find another alternative for him.

My son needed long-term treatment that was affordable, and it simply didn’t exist. Most of it was out-of-pocket, and anything that wasn’t out-of-pocket was short-term. And it just wasn’t enough. It just wasn’t enough.

I think for my son being 11 years in addiction, what he really needed was at least a year away, maybe even longer, that was affordable to us and to him. And it just wasn’t feasible.

Nancy’s story is taken from an interview transcript and has been edited for clarity.

The Problem

Most individuals who receive addiction treatment do not receive evidence-based care or do not receive it in sufficient intensity and duration to promote long-term recovery. The addiction treatment system, in its current form, is not designed to treat addiction as a chronic disease.

Insurers typically reimburse only for short-term or acute care services even though this is neither clinically appropriate nor consistent with the scientific evidence, which shows longer durations of treatment as more effective. Inadequate or ineffective treatment may be a contributing factor to many instances of relapse and perpetuate the perception that addiction is untreatable.

The Solution

Addiction care should be modeled on the system of treatment for other chronic diseases, where patients receive services in primary care, and more complex and severe cases are referred to a specialty care system. Patients must also receive care along a continuum of services. The length of treatment a patient receives should be flexible and contingent on evaluation of the patient’s progress. Insurers should be prohibited from imposing blanket limitations on lengths of stay.

Take Action

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Your story can help others impacted by addiction and become a powerful tool for policy change. By sharing our experiences, we can help others feel like they are not alone and break the stigma associated with substance use.

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