The fact that the Fair Health data excluded Medicaid enrollees, who are more concentrated in New York City than in the suburbs, may account for some of the regional disparities shown in the study, said Robin Gelburd, president of Fair Health. However, state data also show that Long Island has been particularly hard hit by the current opioid epidemic. Suffolk County had the most heroin overdose deaths and the most deaths in which prescription opioids were a factor in 2014, according to a report from the state comptroller's office.
Fair Health is planning statewide follow-up studies that will look at the cost of the services plans are covering to treat opioid addiction, but a national study released last year offers a hint.
In 2015, private payers' average cost for a beneficiary diagnosed with opioid abuse or dependence was almost $16,000 higher than the average per-person cost for all patients, according to a Fair Health report.
Recent state and federal regulations are expanding private insurance coverage for substance-use treatment services. Plans weren't required to cover residential treatment for substance use disorders to the same degree as other inpatient services until July 2014, when an update to the federal Mental Health Parity and Addiction Equity Act went into effect. As of January, insurers in New York must wait two weeks after a patient has been admitted to residential treatment before conducting a review of whether those services are needed—one of several new rules to expand access to opioid abuse treatment that went into effect in the state this year.
"Clearly, the access to treatment and increase in people seeking treatment is driving up costs," said Shira Irizarry, director of behavioral health services at Empire Blue Cross Blue Shield. "But we can't look at those costs in a vacuum."
Empire BCBS now views substance use disorder as a chronic condition and is seeking to expand members' access to community-based services that could help them avoid expensive hospital admissions and emergency room visits, said Irizarry.
For instance, the insurer started contracting about a year ago with the New York Foundling, a human services organization based in Manhattan that provides intensive in-home care for people with substance use and mental health diagnoses.
"I don't think we will know what the outcome is really going to look like," said Irizarry, "until we address what types of treatments are available and make sure our members have access to those treatments that have the proven ability to support long-term sobriety."
"Private insurers in the state see surge in claims related to opioid addiction" originally appeared in Crain's New York Business.
