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Malibu Beach Recovery Center Addiction Recovery Digest

September 1, 2013

www.MalibuBeachRecoveryBlog.com

“Blue Cross Funded My Repeated Heroin Relapses”

John (not his real name) is a heroin addict who suffers from depression, PTSD, and dissociative symptomatology. Until earlier this year he had excellent health insurance benefits from a Blue Cross/Blue Shield policy provided by an East Coast State to its employees. He has used his mental health/substance abuse benefits at least a dozen times to get treatment for his addiction and co-occurring disorders.

He wrote to us after reading here that California State Senator Ted Lieu had instructed Anthem Blue Cross of California to stop sending payments for out-of-network treatment directly to mental health patients and addicts in early recovery.

“More congressman and politicians should address this issue,” he said.

Here is his story:

In 2009 John was treated for mental health and substance abuse issues in Palm Springs, California. Just weeks after discharging he received a check in his name for $9,000. “I called Blue Cross and was told that because the provider was out-of-network, it was assumed I had already paid the treatment center and was asking for reimbursement. As this was not true, I asked what to do with the money and was informed that it was completely up to me. I had integrity back then. I endorsed the check and sent it via Fedex to the facility.”

Like many addicts, John relapsed and went to treatment again. In each case he assigned his benefits to the treatment provider. In each case Blue Cross paid the provider. Then Blue Cross adopted a new national policy of not paying out-of-network substance abuse/mental providers directly.

Blue Cross Funded My Repeated Heroin Relapses

www.MalibuBeachRecoveryBlog.com

In 2012 John went to a treatment center in Malibu (not Malibu Beach Recovery Center). He assigned them his benefits. At their request he officially changed his address to their address. But when he got home he found $25,000 of Blue Cross checks waiting for him.

“You would think,” John says, “that Blue Cross would have questioned the wisdom of paying a person they know has issues in judgment and impulse control, as well as a serious substance abuse problem.

“I knew I had not just won the lottery. I knew this was not my money. In a moment of clarity I texted the facility’s administrative assistant jokingly threatening to use the money to purchase a new car or perhaps use one last time. She did not threaten, or coerce me into giving them their money. She simply told me it would not be right of me to keep it. I deposited the checks, waited for the funds to clear and wired the funds directly to their account.

“More checks arrived. I decided to relapse and told myself I would repay the treatment center later. My casual drug use morphed into a massive struggle with heroin.”

John then checked into another out of network treatment facility, stayed a week, and received a check for more than $6,000. He cashed it along with a check for the services of an out-of-network physician who detoxed him at an in-network hospital.

“Each Blue Cross check created for me a very challenging dilemma -- do I stay sober, or do I use heroin one more time? “ Inevitably, being an addict, John chose heroin -- although he knows that the drug’s potential to kill is heightened after weeks or months of abstinence. He is sure that: “The ability to relapse [provided by Blue Cross] substantially harmed me.”

Blue Cross Funded My Repeated Heroin Relapses

www.MalibuBeachRecoveryBlog.com

He writes: “Had I not been given all that money, I do not think things would have progressed as they did. I would still probably be in grad school. Maybe finished by now. I only had two classes to complete an entire MSW degree before they asked for my resignation because of drug use. I wish more that anything to be able to go back and finish it.

“I wish to help shine a light on how Blue Cross gives hope by allowing addicts and mental health patients to go to treatment, and then places them in the position of losing everything they gained. I mean what good is the treatment if a few days after treatment they give me the rope to hang myself? It's like taking the gun away from a suicidal person and giving them a more powerful one. It's very scary.”

He wants Senator Lieu and other government officials to hold Blue Cross accountable.

“When asked how I could still be struggling with heroin after three years in multiple inpatient programs, I respond inwardly, ‘Thanks in great part to Blue Cross’. Yep, they gave me recovery, then helped take it away. While it was my choice to use, it was the money they sent me that contributed to the course of my addiction. It is a miracle that I have not died with a needle in my arm.”

Blue Cross Funded My Repeated Heroin Relapses

www.MalibuBeachRecoveryBlog.com