My son, Vincent, struggled with addiction for many years. He desperately wanted the nightmare to end, and he knew that it would take time and medical support.
But rather than help him get the care he needed, wanted and was legally entitled to, our family’s insurance company erected barriers. A court-appointed psychiatrist recommended inpatient treatment for Vincent, but the company denied him coverage, saying he did not meet the criteria.
I lost my only child to a fentanyl drug overdose last year at age 25. He deserved better. Tragically, his story is not unique: 2,442 individuals overdosed and died in our state last year. It doesn’t need to be this way.
Addiction is a chronic illness. Yet, the kind of care recommended by medical experts is not accessible to many people due to insurance roadblocks — including lack of in-network providers and denials of coverage. A state attorney general investigation of an insurer found that coverage denials were nearly twice as common for mental health claims as for other medical claims, and nearly four times as common for addiction treatment.
Vincent sought inpatient treatment at least three times. Each time, he was denied coverage because our insurer said he didn’t fit its criteria for “medical necessity.” One reason it cited in the denial letter: he had supportive parents. Somehow, having parents who cared disqualified Vincent from getting the medical care he needed. This makes no sense. Cancer patients would not be denied access to chemotherapy because they have loving families. A medical illness requires medical treatment.
Our insurer limited my son’s care, approving a three-day detox but no proper follow-up treatment, and denied access to FDA-approved medications. Research shows that detox is only the first step in the continuum of care. Imagine treating someone for a diabetic coma and then releasing them without insulin or follow-up care.
Ten years ago, federal policymakers enacted the Mental Health Parity and Addiction Equity Act as a way to end health insurance discrimination against people with mental health and substance-use disorders. The law requires health plans and insurers that cover services for mental health and substance-use disorders to do so at the same level as other medical services.
The New York attorney general’s office has taken steps to hold insurers accountable for violations. And the State Legislature recently passed a law that requires insurers to report on parity compliance. These steps are good, but insufficient.
The system depends on consumers to understand the law and to complain to government officials when they believe their rights are violated. Wouldn’t it make more sense to place the burden of proof on insurers? Shouldn’t they be required to prove their plans comply with the law before they are sold?
After more than a decade of watching the devastating effects of the opioid crisis, we cannot afford to wait. We know that the system is broken: Vincent’s story and countless others make it painfully clear.
That is why I, providers, legal experts and other families have joined the Parity at 10 campaign call on New York to prioritize enforcement of the law. The federal law places the burden of proving a parity violation on the consumer, making it almost impossible to enforce. But states can do better for their constituents. California and Illinois have passed laws that shift the burden back on insurers, where it belongs, to follow the law in the first place. In these states, insurers must prove to regulators that their plans are compliant before they are sold. We call on Gov. Andrew M. Cuomo and the State Legislature to follow their lead and help save lives.
Let’s make sure our insurance system works for people who struggle with addiction and want to get better, like Vincent tried to do.
Sharon Richmond of Northport is an educator and advocate.