Helping children with substance issues: Are insurance companies not covering treatment?

Kelli Belardi says a cancer diagnosis for her son would be preferrable to what she’s going through.

“At least then he would receive treatment,” the single mother said of her yearlong battle with her insurance company to cover in-patient treatment to treat her son’s drug abuse problems.

Things escalated with the teenager after he was denied treatment. He was arrested and attempted suicide on multiple occasions.

He now receives treatment because he is in state custody as a delinquent through the Department of Children and Families. Belardi said she’s not sure what she’s going to do for treatment if his problems aren’t resolved by the time he leaves the state’s care.

“I’ve already drained his college savings account,” she said. That was how Belardi paid for one month of in-patient treatment for her son last year after his second suicide attempt and visit to the emergency room. “It’s better than him killing himself.”

Belardi is one many parents across the state facing this problem, and it’s caught the attention of state lawmakers and officials.

“Insurance companies should be covering this. We have laws in place that say they should be,” said Ben Barnes, the governor’s budget director, at a meeting last week at the state Capitol complex. “Insurance companies have made a business decision somewhere along the line.”

A legislative committee plans to meet Tuesday on the issue, which has prompted a lobbyist for the insurance industry to say he is concerned that it is being politicized.

But although mental illness and substance abuse parity laws are on the books, the Office of the Healthcare Advocate reports that hundreds of parents have approached the office seeking help to appeal insurance denials.

“The No. 1 area people come to us for is substance abuse and mental health coverage,” said Vicki Veltri, the state’s healthcare advocate. “We know for a fact it’s a problem getting access to treatment… Just because there are parity laws in place doesn’t mean it is working.”

In an attempt to avoid having children like Belardi’s son enter state custody in crisis, DCF pays millions of dollars each year to provide treatment for at-risk children with mental illness and substance abuse issues. The agency has said that one of every five of those children have private health insurance.

Although the number of Connecticut families who are being denied coverage to treat their children with mental illness or substance abuse issues is not known, enough parents have complained that lawmakers on the Program Review and Investigations Committee are seeking information. Legislators are to be briefed Tuesday on committee staff’s findings so far on whether people are wrongly being denied coverage. The committee has also been asked to assess if the state is equipped to treat children within the current system.

The most recent federal survey found that 8 percent of Connecticut children ages 12 through 17, and 24 percent of those 18 through 25, have abused or are dependent on alcohol or drugs.

Keith Stover, a lobbyist that represents the insurance industry for the Connecticut Association of Health Plans, said he believes that lawmakers’ suspicions that children are being denied coverage for treatment they deserve are not based on fact.

“There are parity laws in place. I think this debate is not happening based on fact but on political expediency,” he said during an interview. He said that decisions for what is, and is not, covered should be left to the professionals, not legislators.

“With all due respect,” Stover said, “they are not clinicians. Policy should not be made on rhetoric or anecdote but on data.”