Sam Marshall, CEO & President of Insurance Federation of PA, discusses insurance coverage of addiction treatment

Newsmaker Interviews
Thursday, January 11th

Sam Marshall, CEO & President of Insurance Federation of Pennsylvania, discusses insurance coverage of addiction treatment with Frank Andrews.


Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

Sam Marshall who's the president and CEO of the in Pennsylvania insurance federation had a good conversation with them and then twisted desire to be on the show right now Sam thanks for being with us. Pat thank you are having. Now the dog the first quest and I am a lot of question but the first question is the one that dead people asked yesterday our insurer health insurance companies in Pennsylvania. Required to provide coverage for treatment and if so for how long. Yes we are required. That this what is known in Pennsylvania's act six of 1990s. And it applies to both individual and group health insurance plans. Found me it's thirty inpatient days and sixty outpatient days annually. And and one can trade the inpatient could be outpatient is on two for one basis. OK so this onto it at anybody that needs treatment that that's required now to some companies offer more than that is that the minimum. Yet that's that's the minimum NASA mandate. And had sent some companies do. What what year. Killers should be they should understand. That's the role for. Insurance. Coverage. Both individual and group. That's not necessarily. The roll toward government programs such as Medicaid although I think Medicaid mentions that more important it's not a role curb flood that's what are called. So insurance plan. Many large employers have self insurance plans that are not subject to that loss the other thing went bad law. Is that. It it is also subject to a parity rule meaning that that type of coverage can't had different. Conditions in prerequisites. Then say what is applicable or physical ailments. OK not now Sam Eaton yesterday the governor's declaration as the as the guy that runs insurance federation what was your general reaction to that. Our general reaction was a positive one on May not but I appreciate. I appreciate the thought that it was over so. They is that the one concern bid that we had. As an insurance industry. Is that there's there's a lot of correctly a lot of focus on. Ensuring good treatment for all dealer depiction. That we always felt that the best form of treatment is in prevention. And what that. Didn't go into when they you know who may not have been purpose but we think that Harrisburg should be focused. On measures that will also reduce. Video visible prevent OP led addiction to begin as we get people should remember it always starts but they illegally prescribed okay. Stabs us in YouTube you listen listen and there are things that we think Pennsylvania should be doing to reduce the prescription of OP Lloyds. And really in the workplace and health insurance whether it's her children letters for adults. Whether it's in conventional health insurance firm workers' compensation insurance. Now that you just had that he we who we had a little bit of a conversation this morning you mentioned workers' compensation like they bet there's that's something that needs to be focused on can you explain your concerns about that. And we sure and people should realize they did it in Pennsylvania. Workers' compensation is where you see an astoundingly high amount of mobile is being prescribed. It's not surprising because as. Workers' compensation those types of injuries back injury knee injuries in the light. Hog frequently pain management. Conditions. In Pennsylvania had. Who win the business community at the hospital says he's a number of provider groups see ambulances the pharmacist. Had been have all gotten behind aid bill. That has passed. Overwhelmingly in the senate and is now before the house. They would establish in workers' compensation. I think good drug form in the fiddler to monitor deep in the use of both Felix and we know what are called compound medications other pain management formed. I'm as well as putting a uniformly high standard and utilization review on the prescribing. Them. That is shown to work in other states to greatly reduce OP oil prescriptions. I'm in their workers' compensation systems and we'd like to see the saints' success brought pennsylvanians. Now when you say that I'm thinking well people on workers' comp oftentimes have very serious injuries. And one of the things that we were concerned about yesterday is that a lot of the restrictions are hitting people who legitimately need opium race ends and so every in workers' comp do you see that there could be a problem with the kind of tightening their strings there. No hey you know what I mean obviously didn't and from a from a insurers perspective. It's in our financial interest just as much as the end of the of the injured workers. Interest. To get back to work as soon as possible so everybody wants. Nobody is looking to. Limit the amount of needed medication. What you are looking to do is make sure it's the right amount of medication to Pennsylvania. Is at the very top across the country. In terms of OP look prescriptions for injured workers. The word out liar what we'd like to do is bring the same types of measures. Which drug formula essentially exist throughout the health insurance deal and it helped to reduce so good prescriptions and health insurance generally. We'd like to bring that to the workers' compensation us. Does Sam I'm sure you're gonna understand this question a little better than maybe someone just types of questions for you instead cannot insurance company deny you coverage for treatment unless there's a dual diagnosis. Don't know what they mean by they I think I'm so I'm trying to read your dueled at like that they're saying that being addicted to OP was is not enough you also have to have a mentally shall as as well before you can get treatment. Under. I'd be I mean I'd I'd be happy to learn more but I've not heard that. Okay well that's a question for some and and and the reason did they end and the reason I'm I'm I'm. I'm crystal on it. Generally and in good Pennsylvania law is drug and alcohol abuse generally. Oak village are obviously a form of drug abuse and drug addiction. Com I do know big generally. If you are seeking treatment for drug or alcohol addiction you don't need to have. Another. Diagnosis for a dinner diagnosis type. What outlook now what's the next thing you want to see happen to do it does so purely crisis. And I had. I think. I thought they think the number of the measures succeed is that these governor good news emergency ought to make substantially meal. Better coordination of treatment making sure that people aren't you we have a prescription monitoring program making sure that's working. I'm so what you've. You know a lot of this is is getting better education to providers and getting better curbs and so what I think you need to have. Our in all the fonts I think health insurance is doing a lot I think the government insurance programs are doing a lot the workers' compensation system is a glaring hole on it in terms says. Making sure that we have responsible drug formula as they prevent outlaw irons. And making sure that we have responsible review of that. So that you don't have egos and then I think most of provider community is. Is he realizes that and is on board that's why the hospital association for instance. Supports these reforms in need build its now before the house. All right Sam marshals Pennsylvania insurance federation thanks for taking time to answer our questions I'm grateful. My pleasure and had to change.