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Or people seeking help are forced to shuffle from treatment to treatment in a desperate attempt to land on something that insurance will finally pay for. Or they might not get treatment at all.


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Meanwhile, insurance companies can get out of paying for treatment that can be expensive and entail costs for months or even years. And that the people who gathered there in suits and dresses should have been dressing up for his wedding instead. Fahy first used heroin when he was 19, according to his mother, as a sophomore at Catholic University of America.

Fahy improved, but would struggle on and off with his opioid, cocaine, and alcohol addictions for years. But he started using drugs again, which hurt his performance at work, and he was eventually fired.

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Then he broke up with his girlfriend, and moved back home in New Jersey. His drug use accelerated. On February 6, , the family got in an argument in front of Fahy about whether he should get into treatment — and he finally agreed to go. He went to Sunrise Detox, a facility in Stirling, New Jersey, he had previously attended and liked, for inpatient care, signing in around 1 am on February 7. Although self-funded plans generally face fewer regulations than other kinds of health insurance, the plan was still supposed to cover addiction care.

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Searching for a facility that would take Fahy and where coverage would be approved, the family landed on the Transformations Treatment Center in Delray Beach, Florida. Fahy took the news badly. In Florida, though, insurance problems would pop up again. Within months, Fahy relapsed twice. When he tried to get into Transformations after the second relapse in July , even intensive outpatient was eventually denied.

Horizon and Beacon would deny coverage of treatment Fahy sought, recommending a lower level of care. When coverage was approved, it was often after multiple attempts. Horizon and Beacon would sometimes approve coverage at the same level that was previously rejected with little to no explanation about what, if anything, had changed.

This seems to be a common tactic for insurance companies: deny as much coverage as possible, hoping that patients will give up.

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In the last few weeks of his life, Fahy settled for the Living Right sober home and Palm Beach Recovery and Wellness for intensive outpatient — both of which were run by the same owners in Palm Beach County, Florida. But he was so stone-cold dead. But experts argue insurers could play a major role in alleviating these problems — by covering care and holding addiction treatments to a higher standard. And the first two facilities that Fahy tried to get coverage for, Sunrise Detox and Sunrise House, were actually in-network, yet Horizon and Beacon still rejected coverage for them.

Fahy did well earlier in his life on the opioid addiction medication buprenorphine, and studies show that medications are generally the most effective treatment for opioid addiction. But buprenorphine was never offered to him throughout for long-term care.

Ingratitude 101

Part of reforming addiction care in America will require insurers to reject low-quality addiction treatment, pushing patients to higher-quality services. Initially, Beacon denied inpatient and detox treatment at Sunrise Detox from February 7, , and beyond and at Sunrise House from February 9, , and beyond. But in two notes on February 25, , a Beacon staffer identified as Dr. Kho wrote that inpatient and detox treatment should have been covered in both facilities in New Jersey. By the time of the internal review, Fahy had already gone to Florida.

Kho may have had in performing his retrospective review. Regardless, Mr. Fahy was, at the time of his death, approved for an [intensive outpatient program] through September 6, Still, Horizon and Beacon both seem to be aware of a bigger problem. They, along with several other insurers, have teamed up with the advocacy organization Shatterproof to develop better standards for addiction care. That, experts say, is what insurers should be doing. Two federal laws — the Mental Health Parity and Addiction Equity Act, passed in , and the Affordable Care Act, passed in — are supposed to require parity between physical and mental health care: If an insurer covers physical health services at a certain level, and says that it covers mental health and addiction care too, it should cover mental health and addiction services at the same level as physical health care.

Several states, including New Jersey, have passed their own versions of these laws. Beacon has run into trouble with these laws before. In , the New York attorney general concluded that the company, previously known as ValueOptions, wrongly denied addiction and mental health coverage in the state. Generally, though, the laws are poorly enforced. A study by consulting company Milliman found insurers in on average paid over 21 percent more for primary care services than behavioral services, including addiction. Behavioral care was as much as 5.