Del. mother: “A lot of people think a pill is just a pill.”
State officials are proposing revisions to Delaware's insurance code to ensure that people struggling with substance abuse and addictions get the treatment they need.
The new legislation was announced Wednesday through three separate bills, which appear to have bipartisan support.
One bill requires insurers to provide coverage for medically necessary inpatient treatment for substance abuse. It would not require pre-screening, referrals or prior authorization.
Another bill allows Attorney General Matt Denn's office to use consumer protection funds to provide legal assistance to people challenging claim denial. Experts would walk them through the appeal process and offer advice.
"For example, if you were on a federally regulated plan and you got a denial letter…you're a family, you've got a managed care organization on the other side that's got an in-house doctor, that's got in-house claims experts and legal experts," says Attorney General Denn. "Today you've got nothing."
The third bill would create a new oversight committee to help identify and target medical providers who may be over-prescribing painkillers. It would have the authority to make direct referrals to licensing authorities, any referrals to law enforcement will be made by professional staff.
It's stories from residents who know the first-hand experience of having a loved one battle addiction that lawmakers say drove them to this legislation.
Middletown resident Diann Jones says her daughter Nicole, now 25, battled with addiction after being prescribed pain medicine following an accident. According to Jones, it quickly progressed to a heroin addiction.
"A lot of people think a pill is just a pill, they don't realize that it's equivalent of heroin and a needle," says Jones.
She tells 47ABC getting treatment for Nicole proved to be difficult; however, it wasn't because of the amount of resources available.
"We have excellent treatment providers in the community, they were ready and willing to help her," says Jones. "However, her insurance policy which is through her father's state of Delaware insurance plan…they were giving her denial, saying that level of treatment was unnecessary, to try other things."
Jones tells 47ABC. her daughter eventually got the treatment she needed through the Department of Corrections; however, she says if bills like these had already been enacted, she could have possibly gotten the help sooner.
"There's sometimes a very small window of opportunity when someone is willing to get help that we must able to provide that for them," she says. "If these bills were enacted, she would not have had doors closed in her face."
Denn admits the bills have a long process ahead, but he also adds they are "common sense" solutions.
"The scope of the problem, the geographic spread of the problem, the fact that there is bipartisan support…all of those things give me confidence that we'll be successful," he says "But there are people who will be against these bills, and it's not going to be an easy path."
According to the Delaware Department of Health and Social Services, 308 overdose deaths were reported in 2016 compared to 100 deaths in 2009.
