To look at her, Carol is probably the last person you'd think is involved in the heroin epidemic. But she is proof that this drug epidemic can hit any family, living anywhere in Central New York.
Carol is from the northern suburbs, and in addition to being a nurse, and a volunteer firefighter, she's been fighting to get her 24 year old son drug free.
Rich got hooked, after starting on prescription pills, and developed a $200 a day habit, which he supported by stealing, and pawning other peoples' valuables, including his fiance's engagement ring.
When his mother discovered he'd taken her debit card and drained her bank account, she said jail or treatment, but then had to fight to get him treatment.
"I never thought that somebody looking for help for an addict would prove to be that ou don't qualify because you're not currently in crisis," she told us. She is appealing the 3-5 day authorization for treatment by her insurance company.
"We've had people approved initially for a 28 day inpatient stay," says ACR Health's Erin Bortel, "and three days later the managed care company says ok, that's enough. And then they're literlly let out into the community with no structure or support system in place.
We reached out to Excellus Blue Cross-Blue Shield, which gave us this statement, from Communications Vice President Liz Martin:
The benefits available for substance use disorder can vary based on the particular subscriber contract. In general, however, our policies provide coverage for both inpatient and outpatient treatment (both detoxification and rehabilitation). Like any benefits, coverage is subject to medical necessity, which is based upon evidence-based national criteria. We are currently reviewing the package of Bills that the Legislature passed late last week to address the opioid addiction epidemic to determine their impact on the substance use disorder benefits available in our product portfolio.
Steve Wood, with ACR Health, offers some strategies to get longer inpatient care. He points out that medicaid offers more options. He also says 'your doctor is your best advocate' and can often argue more effectively with your insurance company.
And, many people don't realize they can bypass the insurance company if they have a Flexible Health Plan or a health savings account that can pay instead.
It's not just inpatient treatment that is hard to get. Crouse Hospital's outpatient opioid treatment program has 550 beds, and is expanding to 800, and that's still not expected to meet the need: Right now the waiting list is a year long. "It gets discouraging for users, says Bortel. 'They want help, they want it now, not a year from now."
The package of bills designed to speed up treatment and also improve the quality of treatment, just signed by the Governor, is getting generally good reviews from healthcare advocates. Among them, bills sponsored by Sen. Patty Ritchie (R -48th) who represents much of Oswego County and the North Country, which would ensure that doctors specializing in substance abuse are overseeing treatment plans The appeals process will also be speeded up, and there will be more efforts to ensure care.
"A lot of folks who go through treatment and complete treatment successfully will relapse. We're gonna struggle with these issues until we recognize that," says Bortel.
Carol remains hopeful. "He was a model patient," she says of Rich's detox. "And I had my son back."