HMOs need to update old treatment models

I read with great relief Scott Scanlon’s article in the Oct. 26 Refresh section about the link between childhood stress and adult ills. Our 17-year-old adopted son from Russia experienced significant trauma within his birth family’s setting and then in the orphanage. Despite all of the love and resources from which he has been able to benefit since being adopted when he was 7, the effects of his early exposure to drugs, neglect, violence and abuse have had a highly deleterious impact on him, both mentally and physically.

While we have been fortunate enough to help him to the best of our ability, the health care industry lags far behind in recognizing, and reimbursing, new treatments that help a child such as ours. Tired models available within a network are simply not up to the task. Yet HMOs view these new impactful treatments as not being “materially different” than the ones they already offer, thus making reimbursement impossible.

As stated in the article by J. Mark Robinson, co-director of the new Trauma-Informed Community Initiative of Western New York, “The challenge now is to create new treatment models that take childhood trauma into greater account.” While there is a lot of work still to be done, those treatment models are already in existence as evidenced by our son’s current out-of-network treatment. We went out-of-network because what he needed was unavailable in-network. HMOs must assist now, or shell out a lot more later when patients who should have been treated are in even worse shape. Proactive families enrolled in an HMO should not be punished for addressing their child’s needs based on what the child needs rather than based on what an HMO will or will not reimburse.

Brad K. Mazon, Ph.D.