Humana Sneak Attack– Lawsuit Anyone?

I have written about the sleazy actions of health insurer Humana.  Today I filed a formal complaint with the Wisconsin Commisioner of Insurance regarding their practices.  I’ll copy my letter below, rather than take the time to write everything over again.  If there is an attorney willing to work the case on contingency, please contact me.  Likewise, if other patients or physicians are having similar problems with Humana, send me an e-mail through my website at www.fdlpsych.com.
The complaint:
My patient, XXXXXX, has been treated for opioid dependence for two years, using maintenance treatment with Suboxone.  He has maintained sobriety from opioids.  He also suffers from panic attacks and takes Effexor daily.  He uses lorazepam, a sedative, several times per month, and takes a sleeping medication, Ambien, most nights.
The standard of care for treating opioid dependence with Suboxone includes long-term use of Suboxone, particularly in young people (Mr. XXXXXX is in his early 20’s).  Mr. XXXXXX was fully compliant with treatment, including attending weekly psychotherapy and avoiding illicit substances.
In December of 2010, Humana stopped covering Suboxone for XXXXXX.  When I wrote to the company and asked for an explanation, I was told that he was denied because he did not meet the criteria of the company’s ‘buprenorphine coverage policy’.  This new policy was introduced without warning, and stated that people would not be covered if they were prescribed ‘benzodiazepines’ like lorazepam.
I appealed the decision by Humana, stating that the lorazepam was important for treating Mr. XXXXXX’s panic disorder.  But I wrote that his life depended on buprenorphine (Suboxone)– so we would stop the lorazepam immediately so that he would fit their ‘buprenorphine coverage policy’. 
The company continued to deny coverage.  I wrote again, asking for an explanation, and they wrote that Mr. XXXXXX was not eligible because ‘he was taking the benzodiazepine Ambien.’  I noted that Ambien is NOT a benzodiazepine, and does not therefore violate their policy.  But again, I wrote that I would not debate whether Ambien was or was not a benzodiazepine, but instead we would stop the Ambien, given the importance of Suboxone to the patient’s life and health.
The company again denied coverage through the appeal process, writing that ‘maintenance treatment for addiction was not indicated.’  Humana did not explain WHY his addiction treatment was not indicated.  I note that many patients receive buprenorphine for years, and the death rate from untreated opioid dependence is significant and well established.  I appealed the decision, asking for the name of their medical director.  Humana refused to provide the name, even after I called their offices repeatedly.  They continue to deny coverage, and today Mr. XXXXXX received notice that his final appeal was denied.
In summary, Humana was covering maintenance treatment for Mr. XXXXXX’s opioid dependence using Suboxone.  They then abruptly stopped coverage.  Mr. XXXXXX was forced to go through withdrawal without any warning–to him or to his physician–placing him at great risk of relapse and death.  When I attempted to re-establish his coverage, Humana wrote that they had instituted a ‘buprenorphine coverage policy’ without any prior warning. The policy is arbitrary and discriminatory, essentially stating that patients who are treated for opioid dependence are not eligible for treatment of other mental disorders, including panic disorder.
Finally, Mr. XXXXXX was willing to give up treatment of panic disorder in order to receive Suboxone—a medication that is vital to his continued sobriety.  I have repeated notified Humana that Mr. XXXXXX now complies with their arbitrary coverage policy– yet they continue to deny his claim.
This is a very dangerous situation.  Patients who are taking buprenorphine can do very well when compliant with treatment using Suboxone.  Humana pulled the rug out from under Mr. XXXXXX without warning, suddenly denying the medication, and then refusing coverage even when the patient clearly met all criteria according to Humana’s own unfair, arbitrary coverage policy. 
At minimum, Mr. XXXXXX should have his coverage for buprenorphine resumed.  Humana should be punished to prevent this dangerous, discriminatory behavior from hurting other patients.

SuboxDoc Goes Negative!

I received a couple responses to my youtube videos tonight that are worth responding to.  For people who haven’t stumbled across the videos, you will find them if you go to youtube and search under ‘suboxone’ or ‘suboxdoc’.  They are pretty much the same thing as what you read here—a combination of my experiences in treating opiate dependence using Suboxone, education on the actions of buprenorphine, some of my personal ‘theories’ (maybe ‘opinions’ is a better word) on the relationship between sober recovery and buprenorphine maintenance (what I like to call ‘remission treatment’, to distinguish it from methadone maintenance, which works through a different mechanism), and my thoughts on the different treatment options for opiate dependence.

Blogging in general has been an educational experience.  I was initially surprised by the number of people who send out very angry messages to a person who simply tries to share knowledge and advice!  Just today I received a message accusing me of ‘getting my degree from a crackerjacks box’ for my opinion that ‘Suboxone withdrawal is NOT the worst withdrawal ever.’ I didn’t get it there, by the way.    I don’t know how to take the responses posted a few minutes ago that are tonight’s topic;  I am not sure if they are simple questions, respectful disagreements, or sarcastic comments.  You would think a psychiatrist would know one from the other!  Maybe the person will add more angry comments after my post, and then I’ll know for sure.  Or maybe there will be nice comments.  Whatever…

The comments, from someone going by ‘cbarrett34’ on youtube:

Dr. I’m curious, why do you say that there is no cure for opiate addiction? That doesn’t give people a lot of hope, if a Dr. is telling them there is no cure or hope for you. Basically leads to apathy and more using.

(That one was clearly very nice).

And the whole saying, once an addict, always an addict. That’s not a very positive viewpoint either.

(That one is harder to tell, don’t you think?  I might just be paranoid from that crackerjacks comment)

My answer, which as always is just one opiate addict/pain doc/psychiatrist’s opinion:

My first thought is that staying clean from opiates has nothing to do with ‘apathy’.  Maybe smoking pot has something to do with apathy, but people actively using opiates are some of the most non-apathetic people you will ever see!  There is no time for ‘apathy’ for an actively-using opiate addict;  there is that hit that is required every 4-8 hours to avoid being sick, there is that need to scam someone out of money to score the dope that is needed every 4-8 hours to avoid being sick, there is that need to come  up with a good lie to tell the parents/spouse/cops/PO/boss/kids to explain the lousy behavior over the past few months or years…  being an actively using opiate addict is a lot of work!  There is definitely a negative attitude that develops after months or years of using, but it is nothing like ‘apathy’.

Too Negative?
Too Negative?

My next thought is that I wonder what the writer would prefer—‘positive’ lies or ‘negative’ truth?  The idea that heroin or oxycontin addiction is ‘treatable’ is one of the big lies of society;  it makes for good movies and helps keep money rolling in to detox facilities and treatment centers, but if you think I’m wrong, seek out the numbers yourself!  Pick your own criteria for success– one year sobriety, five year sobriety, whatever.  If you look at people in their 20’s who go through residential treatment, the one year rate is way, way, way below 50%, even if you just use the numbers for people who go voluntarily and complete treatment!  Go out to 5 years and the numbers for opiate dependence are ridiculous- sobriety rates of less than 10%!  The writer sees danger in telling the truth about treatment I suppose because the truth will somehow take away ‘motivation’ and cause apathy.  But I see things exactly the opposite.  In my opinion based on how I thought as an actively using opiate addict, a sense of confidence is the ENEMY of sobriety.  As an addict goes from day to day using, and getting deeper into addiction, he/she comforts himself by saying ‘I’m going to get straightened out eventually’.  If the person knew that most people do NOT recover; that he is getting mired deeper in an incurable disease, maybe he will think about seeking help a bit sooner!  And if everyone knew that opiate dependence is a largely untreatable and surely incurable illness, maybe fewer high school kids would pick up in the first place.  I hear addicts say one thing over and over again:  ‘if I only knew that oc would have done this to me I never would have taken it.’  I don’t know if that is true for all of them, but I think that had the truth been known, at least some of them wouldn’t have started.

As far as the comment about ‘once an addict, always an addict,’ that is something that is not even controversial.  Yes–  at least with opiates, once an addict, always an addict.  About 7 years after getting clean ‘the first time’, I assumed that I was cured—after all I had only used opiates for 8 months or so, and it had been 7 years… I had been to hundreds of AA and NA meetings, I had worked the steps all the way through several times, and I never even thought about using!  I would get so annoyed when my old NA and AA buddies would come up to me if they saw me someplace and say ‘we miss you at the meetings, Jeff!’  I would want to tell them to bug off and leave me alone— I’m cured, after all!  I don’t need that crap.  Once an addict, always an addict…. NO WAY!

Had I listened to them I might have saved myself a great deal of trouble.  But probably not, since addicts pretty much need to find things out for themselves.    That is one of the personality traits of ‘us addicts’—we are independent thinkers who don’t think the rules of others should apply to us.  Those words on the Vicodin bottle about dosing and about the danger of dependence?  Those are just ‘suggestions’!

I wasn’t always a fan of the idea of taking a medication to treat opiate dependence.  Even after looking around me and realizing that all of the people who got clean with me had relapsed, I thought that it was better to have one out of ten people in ‘real’ recovery than have people taking medication!  Then I ended up in a position where I actually knew some of the people who were dying.  At NA or AA meetings people talk about the deaths with a ‘tsk tsk’ attitude, as if the person who died should have known better, or almost had it coming, since she stopped going to meetings.  But once I was a person who stopped going to meetings in spite of knowing better, it became harder to blame the dead person.

I have in my mind the images of four smiling people who desperately wanted to be free from opiates.  I knew all four of them pretty well at some point;  none took Suboxone, and all assumed they were going to be fine without it.  After all, they had all gone through at least part and in two cases entire treatment programs.  Three men and one woman, all less than 25 years old, two with children of their own.  Two died from suicides, presumably in part from the shame of failing to get better.  I wonder if they thought, before they died, that they were losers because treatment didn’t work for them?  The other two died from opiate overdoses, one the first time he used after being clean for several months.  I suspect he figured that he ‘beat the disease’;  that is what most of us think as we relapse.  One time won’t hurt, we tell ourselves;  we are different now.  We have been TREATED, after all!  The final person was a woman who had been resuscitated several times in her life, once after an overdose in a drug-treatment halfway house!   Maybe she had a death wish—some addicts seem to use as if they truly want to destroy themselves—or maybe she thought she was blessed by a guardian angel who eventually slept in one day and wasn’t there when she needed him.

To simply answer the writer’s questions without all the stories, I tell people that there is no cure for opiate addiction because my opinion is the same as that of everyone else who treats or studies opiate addiction—   there is no cure for opiate addiction.  As for ‘hopelessness’, sometimes ‘hope’ is just a campaign slogan.  Sometimes ‘hoping’ keeps a person from recognizing the cold hard facts of a situation and taking responsible action.  In medicine and in life, diseases do not always have cures.  Some diseases are simply not curable, and people die.  Want to have ‘hope’ about opiate dependence?  Then DON’T USE OPIATES.

The good news is that while there is no cure, there is a relatively new approach to addiction that is keeping many people alive who would have otherwise died from their addiction.  There are many diseases without ‘cures’—in fact there are probably many more ‘incurable’ diseases than ‘curable’ ones!  But every opiate addict should know the facts:  that he or she will always be vulnerable to relapse, no matter the amount of ‘treatment’.