CHALLENGE ONE - DECIDING TO FIGHT ADDICTION

Challenge Two: Paying For It

Every month, the staff at Caron Treatment Facilities in Wernersville,
Pa., field calls from nearly 2,500 people looking for help to pay for
treatment to kick their addictions.

The call volume points out one of the larger dilemmas of addiction
treatment. You've made the life-saving decision to go for help; now
how do you pay for it?

With 30 days of treatment running anywhere from $14,000 to $30,000,
the cost can seem insurmountable for someone already in a shaky
position to deal with high finance, red tape and insurance companies.

"You're not out of luck, but you face a lot of challenges getting
help," said Dr. Eric Goplerud, the director of Ensuring Solutions to
Alcohol Problems, which reviews state insurance policies for the
Department of Health Policy at George Washington University in Washington, D.C.

If you live in Connecticut, Delaware, Indiana, Kentucky, Minnesota,
New Jersey, Vermont or Virginia, you're fortunate. Laws there require
that insurers treat alcoholism as a chronic disease, offering
coverage equal to that for diabetes or cancer.

But there are nearly as many states where you're virtually
unprotected. In Arizona, Idaho, Iowa, Oklahoma and Wyoming, insurers
aren't required to pay for treatment and recovery programs. There is
little uniformity in the rest of the nation, but coverage is minimal.

For starters, co-payments for addiction treatment are severely
curtailed. Under the strictest of policies, you're expected to pick
up as many additional doctors' visits as necessary, and if you need
the extended treatment recommended for a good chance at recovery,
most carriers will pay for no more than a month at the top end. If
you need help for the mental or emotional health issues often paired
with addiction, your co-payments go even higher.

Uneducated views about the causes of substance abuse actually have
resulted in steady erosion in coverage, Goplerud said. Insurance
companies today pay roughly 25 percent of all claims related to
alcohol and drug addiction treatment and recovery expenses, down from
a third as recently as 1991. The balance is largely absorbed by
public sources, like Medicaid, and the affluent, who can dip into
their own pockets for customized treatment.

That leaves most low- and middle-income Americans struggling to pay
for treatment, or going without.

Treatment and recovery providers are stepping into the void, offering
help in determining how much coverage you're entitled to and where to
find it. Some centers even provide financial assistance.

Caron Treatment Facilities, a nonprofit treatment and recovery
provider, offers what it calls "scholarships" to help offset its
fees, ranging from $23,000 for adults and $25,000 for clients 19 and
under. The expense covers a 31-day treatment program and outpatient
services. Riggs says 35 percent of Caron's clients currently receive
some financial aid. Caron has covered up to half of a client's bill
with money generated by fundraising events that include dinners and
contributions from alumni - and even employees.

The application process is a lot like seeking a credit card. Caron
reviews an applicant's income, debt and credit rating, since the
balance of the bill will fall to the client.

In the workplace, corporate benefits officials still balk at paying
for substance abuse-related expenses. Stubborn attitudes contribute
to the discriminatory policies.

Last fall, Goplerud conducted four focus groups with corporate
executives and benefits managers about the coverage offered for
substance abuse treatment in company-sponsored health plans. While
most of the participants said they were aware of the research linking
biological factors to addiction, "You don't have to scratch too far
below the surface for them to say they aren't sure they want to pay
for 'bad behavior,"' Goplerud said.

A handful of companies have come up with enlightened benefits,
policies and practices. Quad Graphics, a large, private commercial
printing company in suburban Milwaukee that prints Newsweek magazine,
offers employees with addictions 24-hour access to health care professionals.

Antiquated laws also play a role in limited financial support and
access to treatment. Thirty-two states still enforce statutes - the
Uniform Accident and Sickness Policy Provision Laws - enacted in 1947
that allow insurance companies to refuse payment to hospital
emergency rooms if an alcohol-or drug-related trauma brought you
there. To get around the payment issue, doctors may not report the
substance abuse, so those who need treatment don't get it.

Goplerud, whose center tracks, among other trends, the financial
impact of alcohol addiction, calls these "bad laws." Four states and
a number of leading medical and physician-led organizations agree;
they've called for their repeals.