Is insurance-backed care the best care?
The traditional model of treating addiction has encouraged people to assume that patients entering treatment should be able to maintain lifelong abstinence following a single period of specialized treatment.
Accordingly, policy makers allocate limited public health dollars for addiction treatment; insurers restrict the number of patient days and visits covered; treatment centers make no infrastructure allowance for ongoing monitoring; and families and the public become impatient and/or totally discouraged with patient relapses.1
Clearly, the system is failing.
The typical addiction treatment model perpetuated by policy makers and insurance companies is built around first admitting an addicted individual into outpatient programs, then requiring them to fail 2 to 3 times before obtaining an approval for a residential rehabilitation program. If approval for residential rehab is obtained, the typical stay dictated by the insurance companies is 15 to 30 days. Rarely will they pay or reimburse for anything longer.
Treatment facilities that are dependent on insurance provider dollars for their operational needs build their programs around the 15 to 30 day coverage an addict can obtain via their insurance vs. building it around what the individual really needs.
Research shows that an addicted person needs about 45 to 90 days in residential treatment for the best chance of a lasting recovery. This allows time for their brain chemistry to "reboot" and develop the tools it takes to sustain long-term success. In addition, a lasting recovery may involve on-going outpatient services, behavioral therapies and social support after the residential stay is complete.
The cycle of alcohol or drug abuse and the time it takes to successfully break the cycle and heal the brain is not aligned with the insurance companies’ treatment model expectations. In fact, the current insurance model actually impairs a traditional, insurance-based treatment facility’s ability to help addicted individuals long-term.
This is just one of the reasons addicted patients are in and out of treatment over the course of their lives. They’ve been set up to fail by the system that is treating them. For this reason, Enterhealth is a private-pay facility – we are here to help our patients break their cycle of addiction and recover for the long-term.
McLellan et al., 2000. Drug dependence, a chronic medical illness; Implications for treatment, insurance and outcomes evaluation. Journal of the American Medical Association 284(13):16889-1685
Enterhealth’s medically driven alcohol addiction treatment and drug rehabilitation treatment offers personalized residential and outpatient programs in Texas, uniquely suited to where you are in your recovery journey.
Call Enterhealth 24/7 at 800.388.4601 or email us at email@example.com for more information. Don’t just get clean/sober. Get well.