Advocacy

Third-Party Coverage for Addiction Treatment

Adoption Date:
November 1, 1990

Public Policy Statement on Third-Party Coverage For Addiction Treatment

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Background

As America confronts unprecedented problems from the widespread prevalence of alcoholism and other drug dependencies, access to treatment for addictive diseases is becoming increasingly important. Many persons in need of such treatment are covered for their overall health care by a variety of public and private third-party payment plans that severely restrict or exclude addiction treatment services, thereby denying patients access to quality care. These patients face limits on duration of treatment and on total dollar benefits that are far narrower than the limits placed on other medical care they receive.

This situation persists despite the fact that the American Medical Association since 1956 has encouraged the treatment of alcoholism by physicians, that psychoactive substance use disorders have been specifically categorized in the Diagnostic and Statistical Manuals of the American Psychiatric Association, and that addictive disease diagnoses also are integrated into the International Classification of Diseases of the World Health Organization. Regrettably, to provide their patients access to medical care, physicians often are forced into the awkward position of documenting the treatment of a secondary diagnosis, such as cirrhosis, gastritis, angina, or fracture, when the primary diagnosis clearly is alcoholism or another addictive disorder, leading to little or no attention being paid to the underlying addiction.

Position

In view of the inequity and destructive potential of the current situation, the American Society of Addiction Medicine strongly supports:

1. Coverage for all patients, including Medicare and Medicaid recipients, of the full range of appropriate services for the treatment of addiction. Such services should encompass consultation and evaluation, as well as treatment in inpatient, residential, outpatient, and partial hospitalization settings, as indicated by the patient's individual clinical condition.

2. Nondiscriminatory reimbursement for addiction treatment, on a parity with reimbursement for other health care treatment, in commercial and government-sponsored insurance plans, be they traditional (indemnity-type) plans, prepaid (HMO-type) plans, or self-insured plans.

3. State and Federal government legislative and regulatory mandates to third-party payers to make nondiscriminatory coverage available to group health insurance purchasers at premium levels that are both reasonable and equitable.

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