With the state's regulators of insurance and drug rehabs speaking Wednesday, Long Island's teen heroin epidemic has reignited debate about a long-settled question: Who decides where treatment happens?
The answer for 20 years has been health insurance companies. Experts say they have cut rehab costs by approving cheaper outpatient programs and refusing reimbursement for expensive 28-day programs.
That once-controversial approach - blamed by a University of Georgia study for closing one-third of the nation's 28-day residential rehab centers in just three years starting in 1989 - is now accepted in the field.
But on Long Island, it's a flash point again.
"It's happening because you have an adolescent heroin issue, and the insurance companies are denying treatment or they're delaying it," said Mary Silberstein, a board member of the Quality Consortium, a group of 23 Suffolk drug treatment centers.
More than 200 insurance complaints from Long Island rehab centers were lodged this year with the state Office of Alcoholism and Substance Abuse Services. Many were about denials of inpatient and detox treatment for teens.
The agency's commissioner, Karen Carpenter-Palumbo, is scheduled to address the complaints Wednesday with state Insurance Department Commissioner James Wrynn. A spokesman declined to comment, but Insurance Department officials have said insurers have followed state law in most cases.
Insurers said inpatient treatment is approved when medically necessary, often strictly interpreted to mean severe withdrawal. They say no studies show inpatient is more effective than outpatient.
"In an outpatient setting where you still have to deal with those addiction stressors but you're comfortable in your own community, your recovery is stronger," said Dr. Christopher Dennis, medical director for ValueOptions, the company that makes rehab decisions for GHI, which covers 2.5 million New Yorkers.
Some independent experts said 28-day programs are outdated and don't tailor programs to each patient. "The length of stay should depend on the severity of the illness, not the length of the program," said Dr. David Mee-Lee, chief editor of the American Society of Addiction Medicine rehab criteria used by many insurers.
Some experts say teens need at least a short inpatient stay before going to outpatient. Carpenter-Palumbo said there "absolutely" is a need for long rehab stays but added: "There is no magic bullet in 28 days."
On Long Island, inpatient centers such as Westhampton-based Seafield Center have watched the length addicts stay fall from 28 days on average in 1992 to about 14 days on average this year. At Nassau University Medical Center's 28-day inpatient program, it's five days.
Meanwhile, outpatient programs like Confide Counseling in Rockville Centre, said its executive director Art Rosenthal, are flooded with "people we're not equipped to deal with, who need inpatient detox."