Is Health Net losing credibility by limiting insurance coverage to policyholders? - Sovereign Health Group
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“Two substance abuse treatment facilities in California refused to admit my son,” said a distraught Gary Millman of Santa Rosa, California, whose son was struggling with heroin addiction. “The moment they learnt that he had a Health Net policy, they wouldn’t touch him. The facilities don’t know if Health Net would come through on paying for the treatment, yet the insurance company takes your money easy enough,” he grumbled. Eventually, thanks to some personal contacts, Millman’s son made it to a rehab.

Being one of the largest players in California’s healthcare insurance industry, Health Net is not a stranger to controversies, lawsuits or penalties. Nevertheless, the insurance company has been under siege in the last few years for withholding payments to substance addiction and behavioral health treatment centers for months under the pretext of investigating fraudulent claims.

In the recent past, innumerable addiction treatment rehabs have complained to the California Department of Insurance about non-payment of claims by Health Net. Additionally, in 2016, officials at the California Department of Managed Health Care (DMHC), which is another insurance regulator in the state, is said to have reviewed a May 20 complaint, signed by executives and owners of 118 for-profit treatment centers, about Health Net’s unjustified actions.

The substance abuse treatment providers have stated that they cannot afford to accept patients who have policies with Health Net without reimbursements. Moreover, by withholding payments, the insurance company is endangering the patients’ mental and physical health as this restricts their access to addiction and behavioral health treatment resources. To top it, all this inconvenience is being caused at a time when the nation is battling an opioid addiction crisis, making it even more important that people get sober at the earliest.

In fact, in mid-2016, Sovereign Health filed a lawsuit for $55 million against Health Net declaring non-payment of claims for the addiction treatment and behavioral healthcare provided to its policyholders. Sovereign Health has always maintained that Health Net’s blatant denial to reimburse the claims presented by behavioral and substance abuse treatment providers can jeopardize the capacity of rehabs and homecare facilities to continue to provide professional care and services to the needy, especially during troubled times. Further, Sovereign Health has alleged that Health Net has refused to reimburse more than 100 rehabs across the state of California, which is hard hit by the drug abuse epidemic.

In retaliation, Sovereign Health’s centers were “raided” in June 2017. The company has been facing a similar battle in San Clemente and has released a statement alleging that the authorities are harassing the company due to its legal actions against Health Net.

“Health Net has stopped payment for services already provided and it’s unconscionable,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a nonprofit group in Los Angeles representing California’s for-profit treatment centers. “The net effect is some small facilities may go out of business if they have a high concentration of Health Net clients.”

Other bones of contention

A lot of neighborhoods, who do not want addiction treatment centers near them, have also launched an attack on addiction and behavioral health treatment providers. In 2015, three addiction treatment facilities, Yellowstone Women’s First Step House, Pacific Shores Properties and Newport Coast Recovery, in Newport Beach, CA, were sued by the city. According to the Orange County Register (OCR), “The lawsuits stemmed from an ordinance approved by the City Council in 2008 that regulated group homes for recovering addicts – establishing quiet hours, parking and smoking areas and van routes. The three companies sued the city over the ordinance, saying it violated anti-discrimination and fair housing laws, since individuals recovering from an addiction are a protected group.”

The court ruled in favor of the group homes saying that the comments made during the 2008 hearings clearly showed discrimination directed at the recovery group homes. According to city attorney Aaron Harp, Newport Beach had to settle the case for a total of $5.25 million, which it paid to the sober living homes.

Why is getting individuals battling addiction to rehabs so important?

People who abuse drugs often use them to suppress their mental, emotional and physical pain. Regular drug users try to escape from their problems by numbing their abilities to see the reality. Studies suggest that drug users have distinct thinking patterns which enable them to continue abusing drugs despite the negative and detrimental consequences. Their brains are altered by chemicals which, in turn, induce thoughts which exclusively focus on ways and means to obtain the forbidden substances to create the desired high.

According to various studies published in the National Center for Biotechnology Information (NCBI), addictive drugs are known to act on brain reward systems adversely impacting the users’ cognitive abilities, such as the ability to completely process long-term consequences. Besides, people who abuse drugs regularly tend to be more impulsive. Such impulsiveness and the incapacity to process long-term results create distrust in relationships and eventually social isolation, which is fostered further by the ongoing cycle of drug dependence.

In the natural world, it takes a lot of hard work, efforts and some delay to reap the fruits of a reward. Addictive drugs, alcohol and other intoxicating substances, on the contrary, provide an effortless shortcut to these rewards of pleasure, without any delay or time lapse. Slowly, due to changes in the brain, such as desensitization of neurons and reduction in the number of receptors, the brains of those battling substance abuse lose their natural capacity to produce dopamine in the reward system, owing to which, they tend to lose self-control, succumbing to the intense urge to use the drug.

“The way a brain becomes addicted to a drug is related to how the drug increases the levels of the naturally-occurring neurotransmitter dopamine, which modulates the brain’s ability to perceive reward reinforcement,” explains Dr. Nora D. Volkow, research psychiatrist, scientist, and present director of the National Institute on Drug Abuse (NIDA), who has worked very hard to shatter the myth that drug addiction is a character flaw. Nevertheless, three underlying mechanisms, including denial, self-obsession and irrational decision-making, fuel such addictive thought patterns.

Addiction is a serious public health concern

The Centers for Disease Control and Prevention (CDC), suggests that doctors writing millions of prescription opioids have contributed to the deadly epidemic plaguing the nation. In fact, nearly half of all opioid overdose deaths in the country involve a prescription opioid. In 2015, more than 15,000 people died from overdoses involving prescription opioids.

Studies show that every individual has the neurobiological potential to become dependent on substances. On getting hooked onto a substance, the stimuli linked to that substance is capable of capturing that particular individual’s attention, triggering a craving for the substance. Sadly, most individuals fall prey to an addiction more quickly than they might ever realize. The only way to break free from the clutches of these deadly substances is to undergo a specialized treatment for addiction to prescription drugs at a professional drug addiction rehabilitation center.

Sovereign Health understands the plight of someone who is unable to discontinue the use of harmful substances despite the negative impact on his or her life. Our customized addiction treatment services at Sovereign Health of San Clemente are designed to treat the person holistically.

If you or your loved one is battling an addiction to any kind of drug or alcohol, call our 24/7 helpline number or chat online to know about the most effective drug addiction programs at our state-of-art centers, spread across the U.S.

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