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State Senator Lieu Tells Anthem: No More Provider Checks to Addicts, Alcoholics

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State Senator Lieu Tells Anthem: No More Provider Checks to Addicts, Alcoholics

Malibu Beach Recovery Center and the Brentwood House have a new hero.  Meet California State Senator Ted Lieu, who represents a district that includes Pacific Palisades, Brentwood, Santa Monica, Beverly Hills, Redondo Beach and more.

Last week Senator Lieu wrote to Blue Cross asking the organization to recognize the public safety issue created by their policy of sending money due out-of-network substance abuse providers directly to addicts and alcoholics in their first days and weeks of recovery.  He makes clear in his letter that it is equally ill-advised to send these provider checks to mental health patients, echoing the sentiments of a Blue Shield supervisor who told me: “Mental health revenue codes should trigger payment to provider.”

Senator Lieu’s letter, sent to several Blue Cross top executives and the Department of Insurance, states: 

“It has come to my attention that Anthem Blue Cross has been sending large checks directly to drug addicts and patients suffering from psychological disorders, instead of to the out-of-network provider treating these patients.  The patient is then supposed to cash the check and pay the funds to the out-of-network provider.  …patients addicted to drugs or those with mental health issues, however, the patients sometimes use the Blue Cross money for other purposes.  Some of the patients cash the checks and use the money to purchase more drugs, which has led to overdose deaths.

“I am requesting that Blue Cross change its policy…I request that Blue Cross follow what other health insurance companies do and send the checks directly to the out-of-network provider…I believe this simple policy change will save lives.”

Our alumni co-coordinator Ronni Grakal set up the meeting with Senator Lieu, which I attended with alumna Krissie Bergo.  We wanted to personally thank the Senator for co-sponsoring SB 809, the bill we have written about frequently.  SB 809 is slated to provide funding for CURES, California’s almost moribund online, real time prescription drug data base.  That bill was recently adopted by the State Senate and is now making its way through various Assembly Committees enroute to a vote by the full Assembly. 

While at his office, we learned that Senator Lieu has authored SB 62, a very important bill that will require California coroners to report doctors whose prescriptions lead to multiple deaths from overdose.  We promised to lobby our representatives in the Assembly to vote both SB 809 and SB 62 into law, and to ask others in the California addiction community to do the same. 

A final thought about the Blue Cross/Blue Shield national policy of sending  provider payments to alcoholics and addicts in very early recovery.

Is it possible that executives at Blue Cross/Blue Shield still do not know that addiction is a chronic brain disease, impacting the dopamine neurotransmitters which cause us to feel good or rewarded?  Do they not know that several decades of science confirm that the pre-frontal cortex of the brain, which knows how to reason, is hijacked by drinking, using street drugs or taking prescribed narcotics not as prescribed?  And when that happens the more primitive limbic system takes over?

I asked our advisor on neuroscience, Dr. Kenneth Blum, PhD., to describe what happens to the addicted brain when an addict in early recovery receives a large provider payment addressed to him/her.  I asked him to take into account that our mainly middle-class, upper middle class clients come to treatment having stolen money and jewelry from their families and friends to buy drugs, or having prostituted themselves for drugs.   Many of our clients have lost their jobs because of drug use and drinking, and are deeply in debt.

“The brain in early recovery is still dysfunctional.” said Dr.  Blum. “Most addicts and alcoholics cannot make appropriate financial decisions and they have no ability to refrain from doing something harmful to themselves or society.”

In a previous article  I provided examples of addicts who used Blue Cross provider checks to buy drugs that resulted in death, or developed secondary addictions such as gambling and shopping.

Today’s example is about John, whose history of cashing Blue Cross checks may ruin his professional life.   John’s license to practice law was previously suspended for two years by the State Bar Association because he took money from his client trust account to buy drugs.    During treatment the parents revealed that John had also cashed provider checks sent to him by Blue Cross to buy drugs.

John’s family was scrambling to gather money to pay providers threatening to report him to the State Bar Association.  Cashing the provider checks would constitute a probation violation, and almost certainly lead to revocation of his license to practice law.

 

 

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