Heroin help for the insured may be harder to find

Heroin epidemic. (WDTN Photo)
Heroin epidemic. (WDTN File Photo)

The struggle

DAYTON, Ohio (WDTN) -An epidemic we hear about all the time that's led to an increase in crime. It's tearing apart families and affecting every economic class.
But 2 NEWS Investigates uncovers why it may not be that easy for someone to get help for their heroin addiction.

It seems like a simple process.
We get a job, pay into health insurance and if we get sick, we get help paying for it.
But I found out having insurance may actually be making it more difficult for for some to get addiction treatment.

Jennifer Oldiges has a federal job, she pays her bills and has health insurance. She is doing everything she's supposed to do, but she says the system is failing her and her family.

"I don't understand it. I thought insurance was supposed to be a benefit," said Jennifer Oldiges.

Her 22-year-old son Justin is addicted to heroin. Just this month he came to her saying he's ready to get help, but she quickly found out that help wasn't easy to find.
"As soon as I said he has insurance..he was with me. She turned us away," said Oldiges.

Again and again, she was told by inpatient drug treatment facilities around the Dayton area, they couldn't help because she had health insurance.

She said her own insurance company, Anthem Blue Cross, Blue Shield, gave her a list of places to try, but they were all outside of Ohio.
"I never thought that in today's society it was a bad thing to have insurance. That's what most people strive for," said a friend of Oldiges' Barbra Muir

Frustrated and desperate she turned to 2 NEWS Investigates for answers.

"Getting turned away is a big smack in the face," said Oldiges.

We asked around and found inpatient centers that allow addicts to stay there to detox and recover do exist in our area, but many of them only take patients who don't have insurance or who only have Medicaid.

Natalie: "Why don't you guys take insurance here?
"Our target is Medicaid and it's not that they are more or less deserving but we know that population is under-served," said Sr. Director of Woodhaven, Chauncey Wallace.

Woodhaven is an inpatient treatment facility that plans to add even more beds soon. Wallace says they keep patients at their facility for up to six months.

Natalie: Do you think there are enough places right now for people with insurance to get help?

Wallace: "Right now we have a generation under siege. This heroin epidemic is just out of control and we can always use more.”

2 NEWS Investigates found only a handful of inpatient treatment centers in the area that take private insurance. Access Hospital is one of them. It takes patients with the dual diagnosis of psychiatric issues and addiction.

Jennifer called them and was told they do take Anthem, but was let down again when she found out her plan didn't cover her son's treatment. She did not have inpatient psychiatric coverage.
"Our hands are tied, however we try to find other resources," said the COO of Access Hospital Ashley Tincher, "we don't want to turn away people. We want to help them."

And they did. After we contacted Access about why Jennifer was denied help again, they agreed to admit Justin even though the insurance would not cover it.

While that sheds a positive light to Jennifer's story, there's still a coverage problem that exists and 2 NEWS Investigates wants to know why.
"Having insurance does not equate to having access," said Jewell Good with the Montgomery County Alcohol, Drug & Mental Health Services Board.
She said it doesn't surprise her Jennifer and Justin keep getting turned away by local treatment centers because they have insurance.

Good: "So what the treatment providers say is the administrative burden to take that on is so high that they simply choose not to contract with insurance companies,"

Natalie: "So it's a hassle?

Good: "It is a giant hassle and it would require them to add positions to their staffing patterns to cover the administrative cost."

Good said insurance companies don't make it easy for facilities to contract with them.

They require pre-authorizations and things like "stay reviews" to keep a person in treatment day after day.
"Generally, private insurance doesn't want to pay for residential treatment of any kind. They would say intensive out-patient services should be adequate for an addiction treatment," said Good.

2 NEWS Investigates asked Anthem why its coverage didn't work for Jennifer. A spokesperson said they can't comment on her individual case but said most plans include benefits for mental health and substance abuse treatment but the exact coverage varies.

While we continue fighting a drug war that heroin is winning, many addiction experts say the treatment mindset needs to change. More centers need to accept insurance and insurance companies need to make it easier for them to do that.

Natalie: What can be done to change that?
Good: "You know, I think it's going to take a lot of advocacy with the insurance companies themselves. I believe that if the insurance companies were going to authorize even the two week periods of time, they would have less administrative burden on the agencies."

"It's an epidemic. And it's going to get worse, obviously if you can't get them in rehab," said Oldiges.

Are you ready for heroin help?

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