Coverage for alcohol dependence falls short

Many health plans don't heed state laws mandating some level of benefits for treatment.

By Joel B. Finkelstein, AMNews staff. Dec. 23/30, 2002.

Washington -- Treatment for alcohol dependence remains unavailable to many insured Americans, despite state laws mandating managed care coverage, according to a new report from Ensuring Solutions to Alcohol Problems.

"In a quarter of the health plans that we examined, there were ... substantial gaps between what appears to be required by law and what is provided by the plan," said Eric Goplerud, MD, director of Ensuring Solutions, which is a new research unit at George Washington University, Washington, D.C.

The researchers estimate that untreated alcohol problems waste $184.6 billion a year in health care, business and criminal justice costs.

Forty-four states have laws mandating some level of coverage for alcohol dependence treatment. Some state laws require the coverage to be equal to that for other diseases, while others require plans to include a minimum benefit. The rest require insurance companies to offer at least one plan with a minimum benefit.

"While some plans provide a very small amount of coverage, there are huge gaps in what people actually need and what is covered by their health plan," Dr. Goplerud said.

When the researchers applied hypothetical cases to the health plans they studied, they found that less than one-third offer benefits for treatment of alcohol dependence that would be sufficient for their case studies. [...]