Ethical Informed Consent: “Medically and Financially Unnecessary?”

Is it ethically necessary for providers to inform the consumer and/or payer that medically and/or financially unnecessary levels of SUD treatment/ rehabilitation are optional or at best, elective?

Looking through the ASAM Criteria for Addictive, Substance-Related and Co-Occurring Conditions (SUD) levels of care, it is impossible to find equine therapy, yoga, psychoanalysis, five-star dining, massage or oceanfront views. Similarly absent are justifications for expensive and extended residential/ transitional housing beyond measured continued stay criteria.

Unnecessary deluxe accommodations, accoutrements, attractions, and “innovative” treatment practices are absent from healthcare indices and criteria. In such settings, seeking sobriety can become confused with a luxurious and pampering vacation. Egos are inflated rather than right-sized.

“Community standard pricing” is a ludicrous concept which no one comprehends when reviewing the extraordinary reimbursement some programs demand. Many times, the demand for unseemly dollars comes without prior notice or consent. “We’ll accept your insurance and whatever they don’t pay, we’ll give you a liberal payment plan.” What is unsaid is that the insurance will cover ten thousand of your sixty-thousand-dollar bill.

Purveyors of treatment services to the “high earning class” do so with high regard for themselves and their peers regardless of the worth such services provide to the community at large.

Consider the despair and disappointment of a father who spoke of losing forty thousand dollars to a rehab which refused to refund his “deposit” after his bipolar son decompensated and ran at day three from the out-of-state residential program. His son only encountered danger and no benefit from his brief three-day stay. The treatment program justified their no-refund policy and packaged prepaid “deposit” as a disincentive for early discharges…

The son was fortunate enough to be arrested rather than becoming lost in the urban jungle many young adults encounter when their out-of-state residential treatment program exhausts their insurance coverage and boots them to the street.

What are the ethical boundaries in the SUD residential treatment market? Do the parameters of informed consent include medical and financial necessity? Should patients and their families be informed that the expense, the level of care, and the forms of services provided are unnecessary or at best “elective”?

The shame surrounding drug addiction and alcoholism commonly create an atmosphere of secrecy for everyone involved. Families would prefer not to seek professional guidance; prospective patients avoid the terms of treatment altogether. Entrepreneurial providers can leverage this secrecy and shame to their financial benefit.

Shame indeed.

As any entrepreneur, treatment providers find innumerable ways to sell luxurious and unnecessary treatment venues and remedies. Sometimes the buyer has no capacity to measure or judge alternatives. Is it the providers responsibility to coordinate and procure informed consent?

Opposite from the entrepreneur on the addiction healthcare pendulum is an insurance industry which often pretends that weekly outpatient sessions with a psychotherapist should resolve but for the most severe substance use disorders.

Missing from this scene is regulatory agency oversight and professional standards.

Watching this process are families, prospective patients and patients who need someone trustworthy to help them engage in recovery. The tragedy of “elective ethics” and alternative standards is that vulnerable people are being harmed by those who could otherwise help.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS. All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation. Our phone is answered by real people. We see people on the same day they call. (866) 594-8844