WOODBURY - Timing can be critical for drug addicts seeking treatment. So what happens when an addict finally says yes to getting help, but the insurance company says no?
James, a 21-year-old recovering addict, knows all too well that recovery is an uphill battle. He says he started smoking pot at 14, then started to use pills, cocaine and heroin. James landed in the emergency room, suffering from withdrawal symptoms. A hospital doctor then prescribed him a 28-day stay at an inpatient rehab facility, but his insurance company, Fidelis Managed Care, twice refused to cover it.
Fidelis told James it was because he has been through similar inpatient treatment programs three times before. The company said it's "unlikely that another treatment will yield different results."
Dr. Jeffrey Reynolds, who runs the Long Island Council on Alcohol and Drug Dependence, says insurance companies often turn a cold shoulder to drug patients.
"I wish they could spend an hour sitting in our offices watching families crumble because a loved one has finally said yes to treatment but the insurance company has said no," Reynolds says. "It's gut-wrenching."
Fidelis says it can't comment on specific cases but says decisions about addiction treatment are based on state and national standards of care. A spokesperson added that addiction treatment is provided through a variety of approaches, and denial of a specific level of care doesn't mean that no treatment is necessary.
For the full interview with Reynolds, click the video to the left or go to News 12 Extra on Optimum TV channel 612.