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The cost of getting clean: Substance abuse rehab bills can quickly soar

Pastor John Roberts presides over Recovery Worship, a Fargo church designed to help those affected by addiction. Photo by Nick Wagner / The Forum

FARGO -  Drug or alcohol abuse can have all sorts of destructive consequences for an addict, not the least of which is an empty wallet. So when the time comes to get clean, the cost of treatment – typically several thousand dollars – can be a barrier for those who are jobless or deep in debt.

“They don’t get help because they can’t afford it,” the Rev. John Roberts said. “And the downward spiral continues.”

Despite the costs, addicts intent on sobriety usually find a way to pay for treatment, said Roberts, who runs Recovery Worship, a south Fargo ministry open to anyone fighting an addiction.

Sometimes they pay out of pocket. Other times their families cover the costs. For addicts with health insurance, more and more there’s a high deductible to overcome, said Michael Kaspari, director of First Step Recovery.

“Many new deductibles range from $1,500 to $2,500,” he said. “And it’s not unusual for them to be even higher.”

One of the most common ways addicts receive treatment is through outpatient programs, which involve weekly therapy sessions. About 75 percent of patients at North Dakota and Minnesota treatment facilities were in outpatient programs, while the rest received residential or hospital care, according to a one-day survey in 2012 by the federal Substance Abuse and Mental Health Services Administration.

A bevy of factors contribute to the costs of treatment programs, including what insurers will pay treatment providers, so costs can vary widely. And because programs are tailored to individuals, comparing rates is difficult.

How costs vary

At First Step, patients receiving intensive outpatient treatment meet three times a week, and 10 to 12 weeks of this treatment costs about $8,000 to $9,000, Kaspari said. First Step and ShareHouse in Fargo and the Heartview Foundation in Bismarck each charge about $75 for an hour of intensive outpatient treatment. ShareHouse and Heartview also offer residential treatment, and their high-intensity programs cost more than $5,000 per week.

First Step, ShareHouse and Heartview, all nonprofit groups, take insurance but do not have sliding-fee scales for patients with little or no income. Such patients are often treated at one of North Dakota’s eight human service centers, which have sliding fees.

For instance, a single person who earns less than $1,200 per month is not charged for treatment, said Jeff Stenseth, director of the Southeast Human Service Center in Fargo, where the rate for group therapy is $30 per hour and individual therapy costs $85.

“We view ourselves as sort of the safety net,” he said. “The majority of the people we serve are either sliding fee without insurance or a lot of them have North Dakota Medicaid.”

A national study found that in 2011, nearly 60 percent of treatment patients 26 or older reported having no health insurance, 21 percent reported having Medicaid and 10.5 percent reported having private insurance, according to SAMHSA.

Lately, North Dakota’s human service centers have been overwhelmed by people seeking treatment, and they have struggled to find staff, said Kurt Snyder, Heartview’s director. “They have long wait lists. They have chronic job openings.”

Unlike in North Dakota, indigent addicts in Minnesota can check into a private facility and have their treatment paid for with public dollars. This system has the effect of driving down prices at private providers, said Ed Pachel, director of the Lakes Counseling Center in Detroit Lakes.

At Lakes Counseling, a for-profit facility, nine to 10 weeks of intensive outpatient treatment costs $3,000 to $3,200. “We should be charging a lot more than we are,” Pachel said. “We negotiate rates with insurance companies. If that’s as high as they’re going to allow, that’s all they’re going to allow.”

Other treatment centers in Minnesota charge more. An outpatient program at Hazelden, 40 miles north of St. Paul, costs $10,000, and a four-to-six-week residential program costs $20,000 to $32,000, according to Hazelden’s website.

Obamacare’s effects

Directors of local treatment facilities say prices for treatment have not changed much in recent years. But Dr. Robert DuPont, president of the Institute for Behavior and Health in Maryland, believes costs are trending upward around the country.

“Big money has gotten interested in drug treatment,” he said. “A lot of treatment programs around the country are being bought up by big national organizations. That’s never happened before.”

Part of what’s fueling this interest is the Affordable Care Act, also known as Obamacare, which requires insurers to cover substance abuse and mental health treatment. This mandate, according to the White House, will make this type of care newly available to tens of millions of Americans. It’s a lucrative prospect that’s spurred investment in treatment programs, but the extent to which Obamacare will increase access to treatment remains to be seen, DuPont said.

Even though insurers must now cover substance abuse treatment, they sometimes disagree with a treatment center’s diagnosis of a patient and end up declining to cover certain types of treatment, ShareHouse president Nate Medhus said.

Places like ShareHouse offer what they call a continuum of care: treatment options ranging from outpatient to intensive residential programs. In North Dakota and elsewhere, coverage of residential treatment has been eroding, a development that troubles treatment centers.

“We need to have a full continuum of care that needs to have funding for it, so we can treat our clients to the best of our abilities and the best of their needs,” Medhus said.

Last month, Attorney General Wayne Stenehjem issued an opinion that said some plans offered by Sanford Health and Blue Cross Blue Shield of North Dakota likely weren’t following federal law by excluding coverage for residential treatment of adults. The insurers have said they’re working with authorities to comply with the law.

‘By the wayside’

Several times a week, Roberts leads recovering addicts through Alcoholics and Narcotics Anonymous meetings. In listening to their stories, he’s able to offer a sympathetic ear because he knows firsthand the toll addiction can take.

In 2010, Roberts was removed from his position at Bemidji United Methodist Church after he looked at pornography on a church computer. “It was incredibly stupid,” he said. “I had not done anything illegal, and I got really great help.”

Roberts, 59, entered outpatient treatment for compulsive behavior and for alcoholism. His insurance covered much of the cost, and he paid only $20 co-pays for each session once a week for 12 weeks.

Roberts said he benefited from treatment, but he recognizes there isn’t just one method of recovery that works for everyone – a notion DuPont agrees with.

“You don’t have to have treatment to get well from substance abuse,” DuPont said. “Everybody, no matter the poorest or the richest person, can do something about it on their own, and that’s going to AA and NA meetings, which are absolutely free.”

For some, however, treatment is the preferred option. This is the case for one woman, who’s currently a Heartview patient. She asked not to be identified to protect her privacy.

“I drank all of my life. But before, it was social,” she said. In recent years, her drinking “had become more of a dependency and an addiction.”

She managed to hold down a job, but her finances suffered because of how much she spent on booze. “It’s horribly expensive,” she said. “Your bills and everything go by the wayside.”

With the support of relatives, she decided to spend 27 days in residential treatment at Heartview. She’s now in aftercare and attends weekly therapy sessions. Her insurance has covered some of the bills, but her out-of-pocket costs have totaled several thousand dollars, along with lost wages and transportation expenses.

“Yes, treatment costs money, and it is expensive,” she said. “But in the long run, it is a small price to pay for what you get in return.”