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New substance abuse treatment law law affecting private insurers goes into effect next month

CHARLESTON, W.Va. — A new state law that’s been described as insurance coverage for “substance abuse treatment for the middle class” go.es into effect next month

Ryan Weld

The legislature passed SB 401 earlier this year and it was signed into law by the governor. It requires private insurance companies to cover, without preauthorization, up to six months of inpatient treatment for someone whom addiction treatment is deemed “medically necessary.”

The bill’s lead sponsor, Senator Ryan Weld, R-Brooke, said the provisions of the law will fill a current hole in the system.

“People were having to wait while their insurance could preauthorize their treatment in an inpatient facility,” Weld said. “Sometimes they were having to wait quite a while and some people were losing a spot they had in that facility waiting on preauthorization.”

The second part of the law allows the private insurer, after a few days, to work with the facility to see if the treatment for the substance abuse problem is “medically necessary,” Weld said.

“It’s not just a blank check for 180 days in an inpatient facility but it gets you through the front door and then after a certain number of days, depending on the type of treatment you are getting, your insurance will do the review, alongside the facility, and check your records to make sure what you are there for is what you need,” Weld said.

He calls it substance abuse treatment for the middle class. Weld said those who are wealthy can oftentimes afford inpatient treatment for themselves or their family members while those on government insurance can also get the coverage.

“But it’s the middle class getting pinched out. Sometimes the private insurers weren’t covering this kind of thing. They were requiring these preauthorizations that were adding time to the whole process,” Weld said. “That’s where it aimed to really try to help that middle ground of people who really weren’t getting it otherwise.”

Weld’s bill was modeled after a law in New Jersey that went into effect in 2017. West Virginia and New Jersey are now the only states that make the requirement on private insurers.

Many were involved in the bill drafting including the insurance lobby, Weld said.

“We finally got to something that everybody is comfortable with,” he said.

The law takes effect June 8.

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