Rt. 212 Coalition talks insurance in substance abuse treatment

Kasandra Quednau and Shayna Micucci, founders of the Rt. 212 Coalition (photo by Dion Ogust)

Kasandra Quednau and Shayna Micucci, founders of the Rt. 212 Coalition (photo by Dion Ogust)

The Rt. 212 Coalition meeting on substance abuse brought out a handful of people on a snowy Tuesday night at the Town Hall in Woodstock as founders Shayna Micucci and Kasandra Quednau introduced Woodstock police, presented a powerpoint demonstration to identify types of illegal subsances, and gave the floor to Eric D’Entrone, an insurance navigator and Regional Coordinator of substance abuse treatment facilities Arms Acres and Conifer Park. D’Entrone wears many different hats in the process of finding services, including gaining authorizations from insurance companies and helping a substance abusing person navigate the admission process for help. “I’m kind of a boots on the ground person in the community,” D’Entrone said, “providing screening for people who need treatment, helping them access treatment, whether it’s with us or someone else.” He taps into services available throughout Ulster and Duchess County, including government, outpatient, residential, community and mental health services.

D’Entrone explained that, historically, insurance companies did not recognize mental health and addiction. “I think it’s important that people understand benefits and understand some of the laws that have passed in the last decade or so, federally and also in New York State.” He began with the New York Parity law (aka Timothy’s Law) signed by Governor George Pataki in 2006 that mandated insurance companies treat mental health equally with physical health. D’Entrone said, “I remember at times, patients would be coming in and we would be verifying the benefits and [there would be] no detox benefits, no rehab benefits. In 2008, when the Parity law went into effect, the state slowly enforced them.”


Now, according to law, insurance companies must have detox and rehabilitation services in their plans, including 60 outpatient visits following inpatient treatment, and 20 therapeutic outpatient services for family members. Insurance companies can no longer mandate outpatient services before inpatient. Previously, if a person failed as an outpatient, then inpatient would be considered. “It used to be even if you were using ten bags of heroin a day, you had to go to outpatient first. That no longer happens,” said D’Entrone. When the Affordable Care Act went into effect, and was later strengthened through the Federal Combat Heroin Initiative, a mandated process went into place for insurance denials requiring appeals process to be met within 24 hours. While that appeals process is in place, a patient cannot be denied treatment for those days. “If they don’t get back in 24 hours, it automatically reverses the denial,” said D’Entrone.

Openness has also improved as the new laws went into effect. D’Entrone explained that before the laws, “we would have to throw stuff at the wall and see what stuck. They wouldn’t tell us what the criteria were. Now it’s very transparent.” If the claim is still denied, an external appeal would then be filed with the State and that appeal must be decided within 72 hours.

“We have to hold insurance companies accountable,” said D’Entrone, “and that’s how a lot of these changes will take place.” He pointed out important websites that advocate for patients through the Attorney General of New York State Health Care Bureau, and the Office of Alcoholism and Substance Abuse Services. “If there is a possible violation of someone’s rights, they (the State) need to be made aware of this.” For opiates, D’Entrone said, “We used to see denials left and right.” Those patients were instead sent to outpatient services and, “we know that is not good enough, and a lot of people died and a lot of people continue to die from this.”

Around 2014, he said, the organization he works for stopped getting denials. “Especially opiates, there has been sort of a sea change not only with the number of denials that we are not getting anymore, but also there seems to be a greater likelihood they’re going to get approved. It’s not an issue as it used to be.”


Identifying pills

Earlier during the meeting, during the power point presentation, Micucci presented the website Drugs.com and pointed to a section titled, Pill Identifier. She explained if parents may suspect their child is abusing prescription drugs, this would be a place to identify anything found. “If you are finding weird pills in your house, this is something to really think about and maybe start a conversation.” Every pill would have an imprint number to type in. Micucci and Quednau went through a long list of illegal substances including cocaine, marijuana, crystal meth, hallucinogens, and inhalants. What they deem the most poplar abused substances locally, are benzodiazepines and opiates, which include Xanax, Valium, OxyContin and heroin. Micucci said, “Remember that addiction is a mental health issue, and it doesn’t discriminate.”

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