For years, Leena suffered from severe tension headaches. Her stressful job as a detention corona rehabilitation center deputy in a sheriff’s office didn’t help, but she did it for 16 years – and took prescription painkillers every day for each of them just to try to get through the day. She finally switched jobs, and drugs, but nothing helped until she found a successful drug rehab program.
Leena’s doctor prescribed Vicodin for her headaches – three every day. But, soon, three was not enough. She started taking four, then five. After a while, not even the Vicodin helped and she added more drugs. “At one point I was even taking Ambien (a sleeping pill) in the afternoon so that I could bear the pressure in my head. I would drive around on Ambien and just be in a total fog. “
Leena even tried drug rehab: Unfortunately, they just switched her to another drug. “I was depressed and unhappy. When i went to my first rehab, they prescribed me different pills than the ones that I was taking, and I just began to abuse those. It was like switching from apples to oranges, and the problem didn’t go away. The real benefit of that rehab was the holistic aspect of recovery that they taught. ” But, nevertheless, Leena left that drug rehab program still addicted.
Back to work as a sheriff, Leena switched jobs to lessen her job related stress. Now in charge of the trustees within the prison, her hopes failed to materialize. And both her headaches and drug abuse remained a constant in her life. She was eventually fired from her job as a direct result of her addiction, and was arrested on drug-related charges.
“I knew that i needed some more time in rehab, I needed more help. But I wanted this time to focus on the alternative methods that i discovered before. Even though that drug rehab program gave me more drugs, it seemed that if I followed the path of alternative methods they suggested, I could make it. “
Drug Rehab Must be Covered by Pennsylvania Insurance
A Pennsylvania Commonwealth Court has ruled that HMOs and group insurance companies must cover drug and alcohol treatment costs for policy holders referred to detoxification, rehabilitation and outpatient programs by a doctor or psychologist. The unanimous decision will help about 15, 000 state residents with private insurance who need help through drug detox and drug rehab each year.
A 1989 state law requires insurance companies to cover drug and alcohol detox and rehab services. Aetna, Independence Blue Cross, the Insurance Federation of Pennsylvania and other managed-care groups sued the state’s Insurance Department, saying that they should be allowed to review drug and alcohol treatment referrals to make sure that treatment is appropriate. But the court sided with the Insurance Department’s interpretation that treatment would be covered as long as a doctor or psychologist prescribed the alcohol or drug rehab program.
“It’s a really important decision, ” said Deborah Beck, president of the Drug and Alcohol Service providers Organization of Pennsylvania. “Somebody at the end of an 800 number in another state should never be making these decisions. “
The insurance industry could appeal to the state Supreme Court and argue that state law allows insurers to review treatment in other health care areas before paying for care, and that it’s reasonable that alcohol and drug detox and drug rehab programs should be treated the same way. The insurance industry’s reviews of alcohol and drug rehab referrals would be conducted by physicians and psychologists, an Insurance Federation of Pennsylvania spokesman said, adding that when you don’t have scrutiny over treatment patterns, you get increased health care costs.
However, doctors and psychologists who review cases for the insurance companies are paid by the insurance companies. Although this fact was not openly considered as part of the court’s ruling, the fact remains that reviewers’ decisions could tend to favor their employers – the HMOs and insurance companies – rather than the addicts, whos own treatment professionals have already determined that they need alcohol and drug detox and drug rehab programs.
Battling with HMOs and group insurers over desperately needed coverage is nothing new to Americans. The issue has been widely popularized in several books and movies that detailed the horrors resulting from the insurance industry’s penchant to favor their bottom line ahead of patient health.