Right this minute more than 1.7 million adults and nearly 175,000 adolescents in Texas are struggling with a chemical dependency that is taking their lives and adversely affecting their families’ wellbeing and happiness.

If you’re like most Texans, someone you care about is dependent on or addicted to alcohol or another deadly drug. 

Did you know that even when they are ready to kick their addictions and even if they have health insurance to pay for professional treatment, many of them are likely to be denied the insurance coverage they’re entitled to under federal law?

 These denials are costing lives and ruining individual’s chances of recovery from Texarkana to El Paso, Amarillo to Brownsville and every city and town of any size in between. This discrimination against teens and adults struggling to free themselves from addictions cannot be allowed to continue in the Lone Star State. 

I’m a social worker at SOBA Recovery Center in San Antonio, one of Texas’ preeminent substance abuse treatment programs. Every day my colleagues and I work to help addicted adults secure the insurance coverage they or their family members have paid dearly for so they can begin to turn their lives around in treatment.  But even when it’s a matter of life or death, many of them can’t get their insurance companies to approve their admission to treatment, so they can’t begin the process of healing.

That’s why we need your help right now.  Here’s the sad truth:

Despite Congress’ passage of the bi-partisan Wellstone-Domenici Mental Health Parity and Addiction Equity Act in 2008, Texas insurance companies continue to treat their policyholders with substance use disorders differently than they treat policyholders with other medical conditions.  Their denials of coverage have disastrous consequences for teenagers and adults who need treatment from trained addiction professionals to achieve and maintain sobriety and stop using dangerous, life-threatening drugs, such as alcohol, stimulants, hallucinogens, anabolic steroids and narcotics, including prescription medications.

The escalating epidemic of opioid and other prescription drug abuse is headline news every day. What is seldom reported is that insurance companies are contributing to this epidemic by refusing to pay for the treatment addicted individuals need to turn their lives around.

Did you know the 2008 federal Mental Health Parity and Addiction Act requires an insurance policy’s coverage terms for substance use treatment to be no more restrictive than its coverage terms for the care of any other medical condition? This means a company’s rules governing copays, deductibles and coinsurance and its policies that establish the number of outpatient visits or inpatient days allowed for substance use disorders must be exactly the the same as the requirements for any other medical condition covered by the same policy.

It’s actually illegal for an insurance company to punish someone with a substance abuse disorder by restricting the amount of service it will pay for, limiting the number of relapses it will cover, or by increasing the amount a policyholder has to pay for chemical dependency care. But it happens in Texas daily.

The federal act also requires insurance companies to remove annual and lifetime spending limits on substance use benefits; requires policy deductibles and out-of-pocket limitations to combine medical, mental health and substance use benefits; and requires patients to have access to the same number of outpatient visits for substance abuse as they have for other medical conditions. Insurance companies also must provide identical “non-quantitative” treatment limits for individuals seeking substance use treatments as they do for other medical care, in terms of treatment pre-authorizations, utilization review and prescription drug formulary structures.

The federal Act’s rules are supposed to apply to all employer-based insurance plans with 50 or more full-time employees that chose to offer substance abuse coverage, as well as to Medicaid and CHIP managed-care plans.

Unfortunately Texans with substance use disorders don’t have the same treatment benefits citizens of other states enjoy because the Texas Department of Insurance adopted different parity rules in 2011.

That’s just not right!

The Texas Department of Insurance’s substance use parity rules require only employers with more than 250 employees to provide insurance coverage for chemical dependency. In addition, the Department requires substance abuse coverage in Texas to be limited to a lifetime maximum of three periods of treatment, no matter how seriously addicted the person covered is or how many times they relapse.

What if those rules were applied to diabetes, cancer, heart disease or other common conditions? Remember, federal law requires treatment for substance use to be just the same as treatment for any other medical condition.

 How many heart attacks do their insurance policies allow Texans to be treated for? How many broken bones does your health insurance policy cover?

  The Texas Department of Insurance also doesn’t address the federal parity requirement for insurance companies’ non-quantitative treatment limits.  Nor does it require insurance companies issuing policies in the state to follow all the federal interim and final parity rules.

 To add insult to injury, the Texas Department of Insurance also ignores the substance abuse parity requirements of the federal Affordable Care Act required nationwide since 2014. Texas is one of the few states that doesn’t require all insurance companies serving its citizens to cover substance abuse treatment as one of the 10 essential health benefits under the ACA. 

In this context, it’s no surprise the Department also takes a passive stance with respect to enforcing the federal parity rules: It is not proactive in reviewing or monitoring Texans’ health insurance policies for compliance with the Mental Health and Substance Abuse Parity Act’s or the Affordable Care Act’s provisions regarding substance abuse treatment, and its responses to consumer complains about violations of these laws are often slow and ineffectual.

In fact, sometimes the Department is so slow to act that individuals die waiting for its decision on their denied substance use coverage.

Discrimination in insurance coverage for substance abuse treatment cannot continue its fatal course.  Join me in demanding the Texas Department of Insurance immediately:

1. update Texas’ substance abuse parity rules so these conform to the federal interim and final parity rules and the ACA parity rules;

2. implement proactive activities to ensure all health insurance companies comply with the federal interim and final substance abuse parity rules and the ACA parity rules through assertive monitoring and regular reviews of health insurance companies’ policies and coverage procedures.

3. create and implement policyholder complaint processes that quickly review and resolve substance use insurance parity complaints so individuals entitled to coverage receive the treatment to which they are entitled before their health is further jeopardized or they die.

Thank you for joining my campaign to ensure your friends, loved ones and all Texans receive the substance use treatment they are entitled to under United States law.

Shannon Malish, LCSW