Opioids and the Issue of Rehab

Over the last decade, opioid abuse has grown exponentially in the United States. Prescriptions of medication have developed into a quick fix for various health-related issues, as consumers are offered a variety of medication-based options for treatment. This rise in prescription writing from medical professionals, coupled with high levels of stigma and low awareness surrounding mental illness and substance abuse has created the perfect storm.

What’s the scope of the opioid addiction issue in the US?

Opioids include painkillers such as morphine, methadone, Buprenorphine, hydrocodone, and oxycodone sold under brand names including: OxyContin®, Percocet®, Vicodin®, Percodan®, and Demerol®.  Heroin, “Meth”, and Fentanyl are examples of illegal opioids.

The Opioid Epidemic: By the Numbers, an infographic released by the U.S. Department of Health & Human Services, notes that on average more than 650,000 opioid prescriptions are dispensed every day. The document also reads that in the United States 78 people lose their lives every day from opioid-related overdoses. Additionally, a recent report released from the CDC (Centers for Disease Control and Prevention) revealed that fatal overdoses involving heroin skyrocketed from 8% in 2010 to 25% in 2015. That translates to a three-fold increase within a five year span.

What problems do opioid addictions cause for self-funded employers?

As lawmakers work to improve the quality of healthcare and preventative solutions, holes in the healthcare system can leave employers, particularly self-funded employers, footing the bill for drug abuse issues of employees. With the rise of opioid abuse, it has become more and more common for self-insured employers to fall into a financial hole paying for the rehabilitation of their employees.

This is all part of vocational services provided by the employer – services that help the injured worker regain the capability to work again. The idea behind vocational services is that when employers provide aid, often monetarily, to one of their workers after an incident that leaves them unable to work, they are able to retain an experienced employee. This process saves the employer time and money obtaining and training a new employee.

Should the employee initiate rehabilitation at a facility that is out of state, the employer’s insurance will often not have a negotiated rate in place. Naturally, it is impossible for an employer to enter negotiations with every rehabilitation center in the country. If the employer has not taken steps to prevent this type of situation, they are forced to pay the regular rate of the rehabilitation facility, which often costs thousands of dollars a day after the patient is admitted, which could last for many weeks.

These circumstances in the workplace are not as rare as one may think. In an article posted by Lancaster Online, an area fighting its own opioid epidemic, substance-use therapist Chuck Mazzitti mentioned that, “It is it’s safe to assume that between 4 and 8% of workers at a company will have some of addiction.

 What should employers do to protect their self-funded plans from opioid addictions?

With this in mind, self-funded employers need to protect themselves, should this situation arise. Regularly revise your insurance and stop loss plan designs, making sure to include language that restricts where people can seek help while still being covered by insurance. The simple inclusion of phrases such as “in network” or insertion of large co-insurance clauses on out of network rehabilitation facilities can make all the difference in your policies and your company’s wallet. Implementing a regular review process will also allow the employer to vet treatment requests from an employee, as well as keep the process in check throughout its duration. It certainly wouldn’t hurt to bring in a certified medical provider to ensure that the resolution is valid.

If you are a self-funded employer and have any questions on this topic, please contact us to discuss your stop loss insurance coverage.


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