Health Care Reform Act and Addiction -- New Provisions Start in September


The new Health Care Reform Act, which was signed into law in March, has a graduated series of provisions that modify how insurance companies can sell their products. Some of the first changes take effect Sept 23rd and some of these changes may affect alcoholism and other addiction treatment.

Alcoholism prevention
Under the new rules, some preventative medical treatments are covered without cost to patients. This means no copay or deductible. The list can be found at the US Dept of Health and Human Services. Note that "alcohol misuse prevention" is on the list and "screening and behavioral counseling interventions to reduce alcohol misuse by adults" is covered. This is good news, although it falls short of paying for a complete treatment program.

Pre-existing Conditions Rider
Until Sept 23rd of this year, insurance companies will be allowed to deny coverage based on a pre-existing condition -- such as addiction. When the new provisions go into effect, this will not be the case. Even for those who face higher premiums because of a history of addiction can apply to have their premiums lowered -- lowered to match what someone without a pre-existing condition would have to pay. This takes advantage of a national pool and federal money, but it is administered by the States and the procedures vary for each State.

Rescission Prohibited
Rescission is the canceling of a contract after it is in place. For insurance companies, this is one mechanism to drop coverage on a person when they find out about ongoing behavior -- like drug or alcohol abuse. Any new or renewed policy, after September 23, will allow rescission only in instances of fraud. It would no longer be enough to find out you were an alcoholic to cancel coverage for the medical consequences of an alcohol addiction, nor for other addictions.

These and other provisions of the new health care law can be found at: Patients bill of rights.


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