Sometimes, the solution lies in asking questions and knowing which questions to ask. As a 40 year national industry executive and advocate for substance use disorder recovery, I have had to ask many questions in my search for finding what works. Many would agree that we have watched the United States Health Care system evolve into a financially motivated corporation. Rather than an organization to support and facilitate the health and well-being of Americans, it has become a force for motivating its citizens to compete and fight for health care benefits, or be denied access to care.
Trillions of dollars are spent on imprisonment and rehabilitation for criminals, and health care benefits for disease care and sick care are at a premium, not a fraction of those dollars are spent for mental health care for the millions is especially felt in the increasing population of the millions of Americans afflicted with the horrible disease of substance use disorders. Thus, lay the road to Parity, equality of benefits in our health care system.
One in five Americans suffer from substance use disorder (SUD). The national numbers of individuals on opiates, methamphetamines and heroin are mind-boggling, not to mention the average American who has a dependency on prescriptions, pain killers, alcohol, and smoking. SUD is a disease, like cancer, diabetes, and any other serious illness, resulting in financial losses and destruction of health, home, family, career, and possessions. The cost on our society, economy and mental health as a nation is alarmingly high, leading to job loss, homelessness, and crime. Many times, children end up on the streets or in foster homes. The devastation affects not only the individuals themselves, but their children, our future generation of Americans, all of which becomes the financial and social responsibility of our state and federal government. Meanwhile, the costs to Emergency Rooms and hospital surgical floors continue to escalate, but the greatest cost is the loss of human life.
Those who suffer from SUD and seek care are ready and committed, and they do recover, when supported by the work of a quality treatment center. Reports show that for every dollar spent on treatment recovery for these individuals and their families, seven dollars is saved in government spending. Oregon Health Insurance conducted a random and controlled study, reporting that for the segment of individuals whose Medicaid insurance included behavioral health treatments, suicide and depression rates were lower, and general health was higher.
Significant strides have been made in mental health and SUD coverage over the last 5 years, while at the same time access to this coverage has decreased. In 2002, 13.8 percent of covered individuals actually used their mental health benefits, and that percentage increased to only 15 in 2009. Why is that? Much of it is in the fine print, in what is written, or not written, in what is followed, and in the questions, or lack of questions that Americans are asking.
The situation is looking up, however. Substance Abuse and Mental Health Services Administration (SAMSHA), published a new informational resource, to help Americans make the most of our mental health and SUD benefits. Consumer Guide to Disclosure Rights: Making the Most of your Mental Health and Substance Use Disorder Benefits is a powerful tool, providing health benefit details, documents, expected response times, and other resources of information receivable under the Affordable Care Act, the Mental Health Parity, and Addiction Equity Act. In addition, it outlines the steps needed for individuals with SUD and mental health disorders to claim and receive the benefits they’re entitled to, under the full scope of the law. The questions to ask, how and to whom to ask, expected response times, details required to support a claim denial, and steps to take when a claim is denied are spelled out.
The guide is an excellent resource, also, in that it brings attention to current benefit features that are not conducive to our health care coverage, such as the allowance for a 30 day insurance response time. Anyone who has suffered from, or related to someone who has suffered from, SUD knows that, by nature of the disorder, the response time for someone in crisis can mean the difference between life and death.
In March of 2016, President Obama formed the White House Mental Health and Substance Use Disorder Parity Task Force. Simple though it may seem, one of the many intentions of the task force was to require that when insurance companies offer coverage, they must provide that coverage. In addition, results from its 7 month survey reported that Parity in the health care coverage was viewed as a vital issue and that most Americans are not informed sufficiently enough to discern when their parity rights are being violated. The most disappointing result was that there still exists a heavy stigma on the men and women suffering from SUD. That culturally viewed disparity between disease and SUD is the black cloud that still hovers, impeding the progress in the forward momentum needed in the healing of this viable population of Americans.
Our current and newly formed health care acts are an impetus to further raise our awareness of the demand for being advocates for our own self-care. Knowing our rights, speaking up for them, speaking clearly to those in our employee benefits department, our insurance commissioners, and our insurance companies, and demanding access to our rightful care benefits are critical in transforming our health care system. It is up to us to raise our awareness of our nation’s mental health epidemic and disparity, and be the voice that asks the questions we need to ask to heal our people.