Also known as alcoholism, alcohol dependence, alcohol abuse, or alcohol addiction, alcohol use disorder is the inability to control drinking alcoholic drinks as a result of physical and emotional dependence on the drug. Symptoms of alcohol use disorder include a strong urge or need to drink with withdrawal symptoms when alcohol use is decreased or stopped. 54 percent of American adults claim a member of their family has been challenged with alcohol use disorder – making it the most widespread non-tobacco substance disorder. There are many different treatments for alcohol use disorders, including medical detoxification as well as counseling and behavioral therapies.
Support groups can help those with alcohol use disorders manage relapses and cope with required lifestyle changes. If you have received an alcohol use disorder insurance denial, you are naturally discouraged. After all, the treatment has been prescribed by your doctor who believes it can help you with your alcohol addiction. You need a strong, experienced advocate with a long track record of success in getting insurance companies to pay for necessary treatments. Attorney Scott Glovsky is that advocate.
Alcohol Use Disorder Treatments and Insurance Denials for Those Treatments
An impaired ability to stop or control alcohol use in the face of adverse social, work, or health consequences is called alcohol use disorder (AUD). According to the WVODCP, almost 100,000 people will die from alcohol-related causes in the nation annually. Across the United States, as many as one-third of all adults will meet the criteria for AUD at some point during their lives. Those with AUD could require medical assistance to avoid potentially life-threatening alcohol withdrawal symptoms that can result from an abrupt cessation of drinking alcohol. These symptoms can include insomnia, nausea, tremors, anxiety, seizures, visual hallucinations, profound confusion, agitation, and cardiovascular collapse.
AUD treatment goals generally involve reducing and managing symptoms, while improving health and the individual’s ability to function. Some of the most common types of treatment for AUD include:
- FDA-approved medications like naltrexone (Vivitrol and Depade), acamprosate (Campral), and disulfiram (Antabuse). Naltrexone and acamprosate help manage alcohol cravings, while disulfiram blocks the breakdown of alcohol in the body, resulting in unpleasant symptoms when alcohol is consumed. Although there is good evidence supporting the use of these medications, less than 4 percent of those diagnosed with AUD were prescribed one of these medications over the past year.
- Alcohol counseling can include behavioral treatment for AUD which involves working with a healthcare professional to first identify, and then alter behaviors that contribute to the negative outcomes of drinking alcohol. Feelings and situations that trigger heavy alcohol consumption can be addressed by cognitive-behavioral therapy which teaches coping skills and techniques known to change the thoughts that lead to a desire to consume alcohol. Strengthening an individual’s motivation to change behaviors associated with drinking alcohol falls under motivational enhancement therapy. This type of therapy can build confidence and develop skills that allow an individual to stick to the plan while formulating a solid plan for change. Meditation is used in mindfulness-based interventions, allowing those with AUD to focus on the present, choosing one’s emotions, sensations, and thoughts rather than reacting to situations by drinking alcohol.
- Residential treatment and intensive outpatient programs as well as partial hospitalization programs for AUD have been found to be extremely effective. Most residential treatments last for 30 days or more, offering 24-hour a day care with structured, scheduled counseling and therapy sessions, medical care, safe and secure housing, and therapeutic interventions. The goal of residential AUD treatment is to teach strategies that allow patients to lead a life without alcohol while focusing on recovery in a safe, controlled environment. Intensive outpatient treatment involves multiple short sessions each week for group therapy, implementing relapse prevention education, and perhaps a 12-step program. Partial hospitalization programs can include individual therapy, group therapy, family therapy, psychiatry sessions if medication is recommended, and more. Outpatient treatment is less expensive and allows those with jobs or other commitments to receive treatment while maintaining their “normal” life.
- Support groups are usually comprised of others who also struggle with AUD. Those in the group support one another in recovery from or maintaining recovery from alcohol dependency. Support groups are usually not guided by healthcare professionals, so do not fall under therapy or behavioral treatments. There are different types of support groups, such as twelve-step programs like Alcoholics Anonymous, and religious programs like Celebrate Recovery. Most communities offer these support groups at no cost or low cost, so virtually everyone can participate.
Why Might You Receive an Alcohol Use Disorder Insurance Claim Denial?
If you have received an alcohol use disorder insurance claim denial, you may be extremely discouraged about how you will recover from your alcohol dependency. One of the most common reasons an insurer may refuse to cover AUD treatment is because of a supposed lack of “medical necessity.” Because the policyholder’s addiction generally doesn’t include an immediate need for lifesaving care, the insurer may claim it is not medically necessary.
In addition to an outright denial of residential treatment, the insurer may set arbitrary treatment limits related to the duration of treatment or degree of residential vs. outpatient treatments. Many insurers impose restrictive standards or tell policyholders that they are only covered for outpatient treatment even in the face of necessary residential treatment. Most alcohol use disorder insurance claim denials come down to the cost of the requested treatment.
What Should You Do if You Receive an Alcohol Use Disorder Insurance Claim Denial?
Those seeking treatment for alcohol use or other types of substance abuse are often at the mercy of their insurance provider. Unfortunately, insurers have made it increasingly more difficult for those seeking treatment for AUD, drug dependency, and mental health issues. You have the right to file an appeal with your insurer—both an internal appeal and an external appeal if the internal appeal is unsuccessful.
The process can be lengthy, and you must have an advocate on your side from the Law Offices of Scott Glovsky to reduce the cumbersome nature of such appeals. Attorney Scott Glovsky will show that your treatment for AUD is medically necessary, compiling all relevant information regarding treatment, prescriptions, and medical history. We will help ensure your appeal is filed promptly and that the appeal comprehensively details why you will benefit from the specific treatment.
Which Insurance Companies Are Likely to Deny Treatment?
While any insurer could potentially deny your alcohol use disorder insurance claim, the following are California insurers who have denied such claims in the past.
How the Law Offices of Scott Glovsky Can Help
If you have received an alcohol use disorder insurance claim denial, the Law Offices of Scott Glovsky can help. Attorney Scott Glovsky founded the firm in 1999 to hold big corporations accountable for putting profits over people. Scott and his legal team work hard to get justice for our clients. We have a solid reputation and are well-respected in the industry. Our personalized client care is unparalleled—we take fewer cases so we can devote the necessary time and care to each client. Our passion, commitment, and hard work has resulted in a successful track record and a high client satisfaction rate. If results matter, contact the Law Offices of Scott Glovsky.