11 Investigates: State law makes it difficult for addicts to get treatment

PITTSBURGH — A Pennsylvania law intended to help heroin addicts get clean could be hurting them from getting the treatment they need.

11 Investigates looked at Act 106 and found it is a main reason why a local rehab facility has to turn people away.

The heroin problem has reached epidemic proportions in the state. Even people not directly affected by it would agree that getting more people off the drug benefits everyone.

Rehabilitation experts said one of the hardest things is getting an addict to walk through the doors of a treatment center and ask for help. They said it's just as hard for them to tell the addict they can't help them because insurance denied their care.

Holly Martin, the executive director of Greenbrier Treatment, gave Channel 11's Cara Sapida a rare look inside the organization's Washington facility.

She told Sapida that, in a lot of cases, heroin addiction happens so fast for the addict and their families.

"You're getting them here for treatment and you're relieved to finally get them help, and insurance says no. It happens every day," Martin said.

Pennsylvania legislators passed Act 106, which requires all commercial group health plans to provide comprehensive treatment for alcohol and drug addictions, with a minimum seven days of detox.

But Channel 11 News uncovered a giant loophole -- the law only applies to Pennsylvania-based insurance companies. And most Pennsylvanians get insurance through companies with headquarters that are out-of-state.

For example, a local worker with Highmark or UPMC insurance would be covered under Act 106. A local worker with Aetna, UBH, United Healthcare, UMR or Anthem would not be covered.

Martin showed Sapida empty beds inside Greenbrier. She said workers who are there to help have to turn people away.

The average cost to detox from heroin is around $500 a day. Experts recommend addicts stay at a facility for 28 days, meaning a person or family not covered under Act 106 could pay about $14,000 out-of-pocket.

Martin said insurance companies are forcing addicts to detox at home, which does not work. She said the insurance companies know that, and so does the addict and their families.

"They are devastated and say, ‘I'm going to die.’ Families are devastated," Martin added.

CLICK HERE to contact local legislators to ask them to close the loophole allowing insurance companies to reject claims for drug treatment facilities

Cox Media Group