Drug overdoses can require extensive car in the ER and hospital stays. Lamar Odom is a recent example. He’s had a remarkable recovery so far. Due largely to the quick response of emergency services and the hospital.
Who foots the bill? The insurance or the patient?
As a point of reference. I’m familiar with a former coworker that couldn’t get into a private 30 day drug rehab program. The school’s group policy (its actually a policy for all the state universities. Each school is a separate group.) only covers a few days for alcohol detox and then only in very extreme cases. No drug rehab is covered. No long term rehab period. I don’t know what it covers for OD’s and hospitalization. btw, after she was terminated I heard my coworker got into a state sponsored 30 day rehab and later a half way house. I lost touch and don’t know how she’s doing now. She did have a long road ahead to recovery.
Health plans vary. Rehab may or may not be covered. Most, if not all, would cover a hospital stay due to a drug overdose. Emergency hospitalization would seem to be a core benefit of health insurance.
It is my understanding that many insurance policies have opt outs where they will not cover your medical bills if your medical bills are a result of illegal activity. I’m not sure how that relates to drug use, or if the ACA changed it in any way.
Are accidental (or seemingly accidental) non-fatal drug OD’s commonly deemed to be suicide attempts by insurance companies? And if so, does this appear to be a standard and accepted response, or is this just another way for the insurer to weasel out of paying any way they can?
I know that life insurance may not pay for suicide. The reason being is they don’t want to create an incentive for suicide . Sometimes they won’t pay if the policy is new, but otherwise they do pay.
But I have never heard of health insurance not paying for a failed suicide attempt. Maybe people are confusing it with life insurance?
Insurers allowed to deny coverage for all members for injuries caused by a specific activity or for those that arise from a particular cause spelled out in the policy. These are called “source-of-injury” exclusions.
Common opt outs are for things like broken bones from sky diving or bungee jumping. You can usually buy short term insurance to cover that as an additional policy.
However source-of-injury exclusions aren’t allowed if they’re the result of a medical condition. Depression is a bonafide medical illness, as are mental illnesses and substance abuse.
So if someone is depressed and sustains injuries from a self-inflicted gunshot wound, for example, the health plan can’t deny claims for medical treatment.
Federal law makes it illegal to deny claims even if the person is not yet diagnosed at the time of self-infliction.
Suicide is a common exclusion and insurers and the various American state laws are all over the place on this. However if the suicide attempt is directly related to a cause that is clearly diagnosed it is usually paid.
Basically what insurers are asking is this; “if the person did not have the mental illness would he have committed the self harming act?”
However insurers are allowed to set limits for substance abuse and mental illnesses that differ in coverage amounts and time.
Just because you are engaging is something illegal will not let the insurers off. For example insurers have been unsuccessful in denying claims to people robbing banks and getting shot. Insurers have had to pay out to treat the robber.
It depends on the state and sometimes the policy. I can only speak to Massachusetts but such things are covered here. There is a parity law that forces all health insurers to cover mental health issues without exclusion. Addiction and the complications associated with it are a subset of that and they have to be covered. Several other states have similar laws.
Life insurance usually does cover suicide, but not within the first 2 years of the policy. If you buy a policy and kill yourself 2 years and 1 day later then the life insurance will probably pay out.
I work for one of the largest insurance companies in my state. Substance abuse treatment like counseling may or may not be covered, but drug overdoses would be. I’ve yet to see a policy that excluded suicide attempts, and I’ve sseen a lot of them.
As for crime, the usual verbiage is “committing or attempting to commit a felony”. So we don’t have issues where you don’t have coverage if you get into an accident while speeding.
I’ve seen a few skydiving exclusions, but not many. Normally you see things like self-harm or other exclusions on things like student insurance policies, not the regular commercial ones like I deal with