Letter to the Editor

Dear Editor:
I am writing in response to a new policy by Magellan Behavioral Health who manages the payment of drug and alcohol treatment benefits for Horizon Blue Cross for New Jersey State employees and many unions in NJ. Our union members who chose New Jersey Plus to have a solid Preferred Provider Organization (PPO) option because it offers the best benefits for out of network treatment; the members usually pay a higher premium to have this option.

Many of our members, who chose a PPO, do so to exercise the use of out of network Health care providers when they need treatment.

In the past, Magellan and Horizon Blue Cross would honor the contracted benefits and things went fine. The contracted benefits to NJ state employees state that an employee or dependent is to receive up to 30 days of residential treatment if a person required detoxification from drugs and or alcohol.

The past 3 years,Magellan had reduced that on their own to maybe a handful of days of residential treatment days and then maybe a week of Partial Hospital treatment, which is also a form of outpatient treatment and reducing it further to Intensive Outpatient Treatment.

Even with these levels of care, facilities out of state were able to give our members 30 days of treatment.

All government studies show that the longer inpatient treatment can be, the better the outcome and less relapse.

Now, I understand, if someone chooses to go to a non-participating, out of network facility out of state, that their payment is now arbitrarily limited regardless of American Society of Addiction Medicine,(ASAM ) Patient Placement Criteria for medical necessity of treatment. Specifically, Magellan has limited the amount of Intensive Outpatient (IOP) benefits in behavioral health to 3 non consecutive visits on a weekly basis. I believe there is an annual limit but there was never a weekly limit, which completely disregards a doctor’s recommendation for treatment.

This new, apparently arbitrary policy of Magellan, simply limits treatment to 3 non-consecutive days a week, shortly after detoxing a patient, forcing the person to leave in patient treatment and continue treatment on an outpatient basis completely disregarding recommendations of an American Society of Addiction Medicine,(ASAM ) Doctor. In short, treatment ends prematurely.

This scenario is very disturbing and could lead to potentially lethal consequences in that if our members chose to go to an out of network facility; a behavioral health substance abuse program in Florida or any other state, that after spending 2 weeks of intensive treatment or even less time, for substance abuse and sometimes with co-occurring mental health issues, that the recovering members will return home without completing the recommended treatment. This will lead many struggling addicts to relapse, possibly causing a readmission and wasting money on a hospitalization that may have been unnecessary and could cause a fatality. If the members have that benefit available to them; Magellan or any blue cross in any state should honor that. To disregard our members and their medical problems seems callous and possibly liable for the outcome of the medically indefensible actions of insurance companies.

City of Angels prides itself in helping people of New Jersey to get the best treatment possible for their condition. This flagrant disregard for extensive government studies on length of treatment, recommendations of ASAM certified doctors and treatment professionals, is short sighted at best, and will result in unnecessary deaths over time, and handcuffs nonprofit organizations like City of Angels to help people become productive citizens of society again.

Respectfully

Paul K Tessein Sr,
Founder & President
City Of Angels NJ, Inc
PO Box 10237 Trenton ,NJ 08650
24hr Hotline 1-609.910.4942
www.cityofangelsnj.org

Vice President of CWA local 1042