Most people in West Palm Beach know someone that has struggled with an addiction to drugs or alcohol. Whether it was a friend or a loved one, we often encourage that person to seek help through some type of drug and alcohol rehabilitation.
The American Medical Association (AMA) has recognized drug and alcohol addiction as a disease. Because it has been determined by the AMA as a disease, when a person has health insurance, their insurance company needs to recognize the disease and provide treatment coverages.
The 2008 Affordable Care Act (ACA and also known as ObamaCare) along with the Mental Health Parity and Addiction Equity Act state that insurance provider’s coverage for drug and alcohol abuse be equal to that of the medical care benefits offered in the policy. The ACA also makes it clear that an insurance provider cannot use a preexisting condition, such as substance addiction, to decline an offer of coverage.
An insurance policy must cover mental illness to the same extent that it covers other medical conditions to the extent that a medical professional determine to be medically necessary. By definition the term medically necessary is deemed to be “health care services or supplies needed to diagnose and treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of care.”
Unfortunately we have all seen and heard of the cases of health insurance companies not wanting to pay for medically necessary treatments. There have been instances where an insurance company has ceased funding a drug and alcohol rehabilitation program while the patient was in the treatment center. In cases like this, the patient is often discharged due to no funding for their treatment.
If you or a loved one is being treated unfair by your insurance carrier we are here to help you. There is nothing that I find more offensive than when a person is trying to get help and the insurance company is acting in bad faith and not paying a rightful claim. As an addiction recovery lawyer I am here to help you fight for your sobriety and to be treated fairly by your insurance company.