Alcohol Withdrawal in the E.R.: A Maze of Red Tape

You’d think recent advances in health reform would have made it easier to get mental health and substance abuse treatment. Parity legislation, for example, requires insurers to cover mental health and substance abuse treatment comparably with physical health.

Think again.

In a Jan. 3 New York Times article, “A Long and Winding Road to the Emergency Room,” Paul Christopher, M.D., a Rhode Island psychiatrist, describes the case of an adult man so dependent on alcohol that he suffered seizures when he went without it.

Despite the fact that he desperately needed medical care, red tape kept him from getting the hospital bed that his insurance was supposed to cover.

The man showed up at Christopher’s psychiatric emergency room in serious withdrawal. He couldn’t be admitted to a bed in that facility, however, because his insurance wouldn’t cover admission to that particular hospital.

Welcome to what Christopher called “the second-class world of substance-abuse treatment, where insurance companies contract with selected hospitals and doctors to deliver care at bargain rates.”

The staff at Christopher’s hospital called around to the hospitals where the man could be admitted under his insurance and found one with an empty bed. Good, right?

Nope. The doctor there said his hospital would not admit the patient until he’d been cleared for other medical problems. The patient needed lab work and an electrocardiogram done first — test results that could take a day to get. This, in spite of the fact that he was already in withdrawal and didn’t have a day to waste.

Nevertheless, the patient was duly sent off to a medical emergency room to get the tests. Christopher hoped the tests could be done in time to get the patient in a bed by the end of the day. Then Christopher could begin the process of getting the man’s insurance company to authorize care — something it would not do until he’d been cleared for entry into the hospital in its network.

The patient returned to Christopher 10 hours later with his completed tests. By then, however, there was nowhere to go. The open bed had been filled. Luckily, Christopher’s hospital had an open bed, and he was admitted there — very likely on the hospital’s own dime. 

To summarize: the patient showed up at a psychiatric hospital seeking treatment. Admission to that hospital was not covered by his insurance. To get into one covered by his insurance, he had to go to a medical emergency room to have tests done, then return to the first psychiatric hospital to get insurance authorization before he could go to the hospital with a bed.

By the time he jumped through all the hurdles, the bed he’d been hoping to get into had been filled.

All this for a patient who actually had insurance. A far cry from treatment on demand, no?