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  • Mary Burns

Suggested changes to Bill S3 signed into law February 2017.



1. The law states that “The benefits for days 29 and thereafter of an inpatient care shall be subject to concurrent review by the insurance company* as defined in this section. A request for approval of inpatient care beyond the first 28 days shall be submitted for concurrent review before the expiration of the initial 28-day period.”


Suggested Change – “The benefits for days 91 and thereafter of an inpatient care shall be subject to concurrent review by the insurance company as defined in this section. A request for approval of inpatient care beyond the first 90 days shall be submitted for concurrent review before the expiration of the initial 90-day period.”

Reasoning - As currently worded, the bill allows the insurance companies control of whether inpatient treatment should go beyond 28 days. This review should not occur until after 90 days of treatment. According to the Principles of Drug Addiction Treatment: A Researched Based Guide (Third Edition) published by the National Institute on Drug Abuse, “Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop their drug use and that best outcomes occur with longer durations of treatment. Research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and for treatment lasting significantly longer is recommended for maintaining positive outcomes.”


According to Alcohol.org, “A 90-day alcohol (inpatient) rehab program can allow a person time to build and develop habits that can be carried into recovery. It takes time to form a habit, and long-term rehab programs can provide this time in a stable and secure environment.”


Many who I know that have gone through 30 days of inpatient treatment, have stated that 30 days is just a beginning and during that time the fog is just beginning to lift. Thirty days is not enough and at least 90 days of inpatient treatment should be the standard of care for those who want to attain recovery.


a. If an individual due to personal responsibilities (job, children, etc.) cannot commit to 90 days of inpatient treatment and choses to leave the facility after 28 days or chooses to attend intensive outpatient treatment first but then determines that they cannot stay in recovery, they should be able to sign themselves into an inpatient rehab or back into an inpatient facility without penalty for days they are entitled to for the year.


b. Attendance of an outpatient treatment program should not be required by an

insurance company before inpatient treatment is approved.


Reasoning - Outpatient treatment varies in the types and intensity of services offered.

Such treatment costs less than residential or inpatient treatment and often is more

suitable for people with jobs or extensive social supports. It should be noted,

however, that low-intensity programs may offer little more than drug education

(National Institute on Drug Abuse).


2. Suggested Change - Once 90 days of inpatient treatment is completed, the patient should continue their treatment by attending intensive outpatient treatment until their 180 days of treatment that is covered by law is fulfilled. This should begin immediately after release from inpatient treatment. The 180 days of treatment that an individual is entitled by law should run contiguously.


Reasoning – “Research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and for treatment lasting significantly longer is recommended for maintaining positive outcomes. (National Institute on Drug Abuse)


3. Suggested Change - Once treatment is completed, insurance companies should cover individual therapy for patients to enable them to maintain their recovery for as long as deemed appropriate by a licensed drug addiction counselor, therapist, psychologist or psychiatrist.


Reasoning - “Research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and for treatment lasting significantly longer is recommended for maintaining positive outcomes. (National Institute on Drug Abuse)


4. An individual that goes to a hospital emergency room asking to be admitted to a detoxification unit needs to be admitted regardless of their outward symptoms and/or behaviors or where they fit on the American Society of Addiction Medicine (ASAM) Patient Placement Criteria.


Reasoning – Due to the stigma surrounding addiction, it is highly improbable that an individual that is not struggling with substance use disorder will ask to be admitted to a detox unit. When an addicted individual has a moment of clarity and decides that they want help, help should be immediately available regardless on his/her drug habit and how long they have struggled with substance use disorder.


According to the Principles of Drug Addiction Treatment: A Researched Based Guide (Third Edition) published by the National Institute on Drug Abuse, “Treatment needs to be readily available. Taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.”

5. After detox is completed, an individual must be directed immediately to a 90-day inpatient program. If a bed is not available, then they should be given a date in which a bed will become available. During this waiting period, the individual will be assigned a recovery coach or attend outpatient therapy to help them maintain their newfound sobriety.


Reasoning - According to the Principles of Drug Addiction Treatment: A Researched Based Guide (Third Edition) published by the National Institute on Drug Abuse, “Detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Patients should be encouraged to continue drug treatment after detoxification.”


6. Medicated Assisted Treatment should be used whenever possible and covered by insurance companies. Costs for long acting drugs, such as, Vivitrol should be covered and used in place of daily medications to help individuals stay compliant with their treatment and prevent relapse.


Reasoning – Medicated assistant treatment allows a patient to engage more readily in counseling and other behavioral interventions essential to

recovery. (National Institute on Drug Abuse)




* Insurance company refers to any company that falls under the umbrella of the hospital service corporation, medical service corporation, health service corporation, individual health insurance policy, group health insurance policy, individual health benefits plan, small employer health benefits plan, health maintenance organization, state health benefits commission and school employees’ health benefits commission.



List of sponsors and cosponors

https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S3



Latest bill text

https://legiscan.com/NJ/text/S3/2016



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In trying to promote my book and start a conversation about how insurance companies cover addiction treatment, I was a guest on The Addicted Mind Podcast and The Addiction Podcast.


Below are the links. I'd appreciate your listening and commenting on what I've said and joining the conversation.


https://theaddictionpodcast.com/2021/01/mary-burns-saving-eric-a-mother-changing-the-face-of-addiction/?doing_wp_cron=1612897219.6779060363769531250000


https://theaddictedmind.com/saving-eric-with-mary-burns/


Mary Burns


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  • Mary Burns

Updated: Jul 24, 2020

Drug addiction is at crisis levels in this country. Why is this so? After going through the journey of drug addiction with my son, I think that this crisis might be due to the lack of a treatment “roadmap” for addiction. By treatment roadmap I mean that there isn’t a treatment protocol that is used that has proven to work for most of those who want to recover from substance use disorder.

I will use breast cancer as an example. I have never had breast cancer but have know quite a few persons who have been diagnosed and treated for this illness. Once a person is diagnosed with breast cancer, there is certain protocol or “roadmap” that is followed to treat the cancer. Once the type of breast cancer is determined, the cancer is removed either by mastectomy or lumpectomy. Once the removal surgery is done, the individual will most likely receive chemotherapy. The chemotherapy is tailored to the cancer’s stage, the person’s genetics and the location of the cancer in the breast. Once chemotherapy is completed, many individuals go onto receive radiation. Again, the radiation is tailored to the individual’s cancer. After radiation some individuals will also take Tamoxifen for a number of years to keep the cancer from returning. As you can see, there is a general order or “roadmap” that is followed by oncologists to treat this disease and yet the treatment is tailored to the individual depending on the specific type of breast cancer.

Why isn’t there this type of roadmap for addiction? Why are some people required by their insurance companies to go through outpatient treatment first while some insurance companies will immediately give inpatient treatment? Why do some insurance companies cover only a 30-day stay at an inpatient treatment facility and others a longer stay? Drugabuse.gov states that “research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.” Three months of what type of treatment? Three months of inpatient treatment, outpatient treatment or a combination of both? Which option will give the best outcome?

There is a great variation on the types of treatment that an insurance company will pay for? Why is this and why is each individual not given treatment that has been proven to work for the majority of people trying to recover from addiction? Do we even know what types of treatment works best for most people in trying to attain recovery and in what order an individual should go through these steps? Why are people forced to navigate through the maze of treatment options alone? Would this lack of a roadmap for treatment be tolerated for any other disease?

I think the answer to that has to do with the stigma that has surrounded addiction and the fact that many people see the disease as a lack of moral character. We now know that addiction is considered a disease of the brain. The American Medical Association defines addiction as a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance (s), such as alcohol or drugs, to the point that it takes over their life1. If the American Medical Association considers addiction a disease, it’s time we began to treat it like one.

My book clearly shows the reader of the shortcomings of addiction treatment. The treatment that my son was given, thus what the insurance company would pay for, was not what my son needed. He needed long-term, intensive treatment as soon as he asked for help. We need to determine what works best for most individuals. We need a roadmap for recovery!

1 https://www.psychiatry.org/patients-families/addiction/what-is-addiction#:~:text=Addiction%20is%20a%20complex%20condition%2C%20a%20brain%20disease,the%20point%20that%20it%20takes%20over%20their%20life.

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