Seabrook House Ends 20 Plus Year History With Aetna After Continued Disputes Over Parity Violations
SEABROOK, N.J., July 10, 2013 /PRNewswire-USNewswire/ — Seabrook House terminated its contract with Aetna effective July 7, after receiving dozens of denials for residential treatment deemed medically necessary by Seabrook House physicians.
Seabrook House ended an over 20-year, in-network relationship because Seabrook House believe Aetna’s conduct is not consistent with the federal Mental Health Parity and Addiction Equity Act of 2008 and The Affordable Care Act of 2010.
“We have been on the front lines in the war on drugs and we have found that often the hardest battle we fight each day is with the insurance companies that are in the business of denying the coverage its members are entitled to receive,” said Ed Diehl, President of Seabrook House. “There is an epidemic in our country. Young opiate addicts are dying of drug overdoses every day, and those that are seeking treatment for their addiction are being denied the proper level of care.”
According to Diehl, Aetna Health has violated the Mental Health Parity and Addiction Equity Act of 2008. The law requires group health insurance plans that offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan.
“Aetna does not wait until someone is in stage four cancer before they treat him or her, nor do they tell a diabetic that has had a relapse, that he or she is not worthy of care; yet the insurance company regularly penalizes those seeking addiction treatment for not being sick enough, or motivated enough,” said Diehl.
Diehl also stated that Seabrook House terminated the contract because: denials being upheld after numerous appeals; Aetna Care Managers and Aetna physicians continue to ignore the American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC-2); Aetna Care Managers and Aetna physicians continue to make authorization decisions based solely on financial status of patients and their families; and the process of obtaining initial urgent admission authorization for Aetna members has increased from an average 12 minutes to over 2 hours. Seabrook House has attempted multiple times to work out issues with Aetna, but these have been unsuccessful and we believe that we have no choice but to end the relationship.
“The Affordable Care Act of 2010 expanded coverage to children up to the age of 26 because our government realized the need to provide health services to these young adults,” said Diehl. “Since the law took effect the number of denials for those 18 to 26 years old has skyrocketed.”
In May, New Jersey Governor Chris Christie signed the Overdose Protection Act. At that signing the Governor stated his belief that every human life is precious and that it is our obligation to prevent tragic deaths from drug overdoses.
“Governor Christie has been vocal about the ongoing efforts here in New Jersey to prevent senseless deaths due to drug addiction and to get people into treatment, yet Aetna has continued to deny care, especially for residential treatment,” said Diehl. “In just the last few years, I am aware of at least 17 deaths that occurred after patients sought treatment at our facility but were denied the appropriate level of care from Aetna. Seabrook House could no longer ignore the travesty that is happening, and had no choice but to end our 20-plus year in-network relationship with Aetna.”
“Aetna needs to realize that the cost of denying treatment now will ultimately cost so much more in the future,” said Diehl. “Eventually those left untreated or not approved for the proper amount of treatment face deeper physical and mental health obstacles as the disease of addiction progresses. Seabrook House wants to ensure that the necessary level is provided.”
For the list of disputed parity violations, victim and additional documentation please contact us.
Contact Sara Nicoll at 856.455.7575 ext 1151, or 609.477.8070 (after hours) for documents and to speak with Ed Diehl.
Seabrook House is an internationally recognized, private CARF-accredited addiction treatment center with several locations. The main facility is located in Bridgeton, NJ, convenient to Pennsylvania, New York and surrounding states. Our 90-day transitional living facility for men, Seabrook House West, is located in north central Pennsylvania in the town of Westfield. Our 90-day transitional living facility for women, Changes for Women, is located on our main campus. We have additional outpatient offices in Cherry Hill and Northfield, NJ. Seabrook House has been helping families find the courage to recover from alcoholism, drug addiction and substance abuse since 1974. To contact Seabrook House, please visit the organization’s web site at www.SeabrookHouse.org, or call the 24-hour help line at 1-800-761-7575.
SOURCE Seabrook House