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Heroin users seeking treatment may hit insurance barriers

Patty DiRenzo’s son, Salvatore Marchese, died of a heroin overdose after being denied treatment in some facilities.

Mel Evans/associated press

Patty DiRenzo’s son, Salvatore Marchese, died of a heroin overdose after being denied treatment in some facilities.

NEW YORK — As the ranks of heroin users rise, increasing numbers of addicts are looking for help but are failing to find it — because there are no beds in packed facilities, treatment is hugely expensive and insurance companies will not pay for inpatient rehab.

Some users overcome their addictions in spite of the obstacles. But many, like Salvatore Marchese, struggle and fail.

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In the course of Marchese’s five-year battle with heroin, the Blackwood, N.J., man was repeatedly denied admission to treatment facilities, often because his insurance company would not cover the cost.

Then one night in June 2010, a strung-out Marchese went to the emergency room seeking help. The doctors shook their heads: Heroin withdrawal is not life-threatening, they said, and we can’t admit you. They gave him an IV flush, and sent him home.

Marchese, then 26, and his sister called multiple inpatient clinics only to be told: We have no beds. Eventually, Marchese found space at a facility but was released 17 days later when his public funding ran out. Less than three months later, Marchese was found dead of an overdose in his mother’s car.

‘‘Heroin is life-threatening,’’ said his mother, Patty DiRenzo. ‘‘We’re losing kids every day from it.’’

Of the 23.1 million Americans who needed treatment for drugs or alcohol in 2012, only 2.5 million people received aid at a specialty facility, according to the federal Substance Abuse and Mental Health Services Administration.

Heroin addicts are a small slice of overall drug users, but their numbers nearly doubled from 2007 to 2012, to 669,000. The number treated for heroin also increased, from 277,000 to 450,000.

At issue is whether these addicts are getting the treatment they need to successfully beat their habits. Advocates say they are not, partly because the insurance industry has not come to grips with the dangers of heroin withdrawal and its aftermath.

It is true that, unlike withdrawal from dependencies on alcohol or benzodiazepines like Xanax, heroin withdrawal does not kill. But it is so horrible — users feel like their bones are breaking and fluids leak from every orifice — that many are drawn back to the drug, with fatal consequences.

Even if addicts survive withdrawal, they often relapse if they fail to make it into treatment. That’s when many overdoses happen, because they try to use as much heroin as they did before, and their newly drug-free bodies can’t handle it.

Because withdrawal is not directly deadly, most insurance companies will not pay for inpatient rehab, said Anthony Rizzuto, a provider relations representative at Seafield Center, on Long Island. They either claim that the user does not meet ‘‘criteria for medical necessity’’ — that inpatient care would be an inappropriate treatment — or require the user first try outpatient rehab.

‘‘Ninety-nine-point-nine percent of the time, we hear ‘denied,’ ’’ Rizzuto said. ‘‘And then we go to an appeal process. And we get denied again.’’

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