Delaware Bill Aimed at Substance Abuse Insurance Coverage

By | April 6, 2017

House lawmakers have unanimously approved legislation aimed at ensuring that people struggling with drug addiction get the help they need.

Supporters of the bill say denial of insurance coverage for substance abuse treatment is a major source of failed treatment efforts by people seeking help, and also a cause of the shortage of adequate treatment facilities in Delaware.

The legislation, which cleared the House with no debate Tuesday, is aimed at ensuring that people with private and public insurance coverage get the treatment they need, which often requires repeated attempts to get help.

“Insurance companies should do the right thing by their insurees,” said chief sponsor Rep. Helene Keeley, D-Wilmington. “If they struggle, if they stumble, they should have the right to go back.”

Among other things, the bill allows the attorney general’s office to provide legal assistance to those seeking benefits from Medicaid, traditional health plans, or employer-funded health benefit plans.

It also requires Medicaid and private insurers to notify people of the possibility of legal help in challenging claim denials.

Meanwhile Tuesday, the Senate passed related legislation that requires insurers to provide coverage for medically necessary inpatient treatment of alcohol and drug dependencies. Insurers in most cases would have to wait until after 14 days of treatment before conducting a “utilization review” of the services being offered.

The bill also prohibits insurers from requiring precertification, prior authorization, pre-admission screening, or referrals for the diagnosis and treatment of drug and alcohol dependencies.

The Senate bill also mandates that a health benefit plan that includes prescription drug coverage must allow immediate access, without prior authorization, to a 5-day supply of medications for drug and alcohol dependencies where an emergency medical condition exists.

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