Senate Bill 999, sponsored by State Senator Dave Cortese, has passed the Senate Health Committee, Senate Appropriations Committee, and a vote of the entire State Senate. It has passed the Assembly Health Committee, Assembly Appropriations Committee, and a vote of the entire Assembly. Yesterday the Senate formally accepted amendments the Assembly Health Committee made, and the bill was sent to Governor Gavin Newsom’s desk. Please write to Governor Gavin Newsom immediately and ask him to sign SB 999 into law. Send your letters to firstname.lastname@example.org. A sample letter can be found on www.friendsofsb999.org
The purpose of SB 999 is to stop insurance companies from hiring unqualified doctors who know nothing about addiction to deny required addiction treatment. They have been doing this regularly since at least 2010.
Back in the day, when my husband Oleg Vidov and I owned Malibu Beach Recovery Center (“MBRC”)we, like others in the addiction community were “stalked” by Dr. Timothy Jack, an Anthem psychiatrist known as “Dr. ‘No.’” If Anthem required a peer-to-peer review to determine if a patient already in treatment needed more time and assigned “Dr. ‘No’” to do the review, we immediately knew he would deny.
Here are two MBRC cases I remember from those years: A diagnosed schizophrenic got drunk, took a gun out of his father’s desk drawer, and shot up the upper middle-class neighborhood where the family lived. Dr. Jack determined that after detox he was perfectly suited to go home and attend outpatient (putting addict and community at high risk).
Then there was the client who came in on bath salts, at a time when it was being reported in the press that addicts on bath salts were cannibalizing innocent bystanders (bath salts is a lot like PHP which removes all inhibitions). Dr. Jack determined it was just fine for him to live in the community and attend outpatient (putting addict and community at high risk).
Finally, in December 2014, CBS-TV’s popular news magazine “60 Minutes” outed Dr. Jack. They determined Anthem was paying him $25,000/month to deny 92% of the cases assigned to him.
Dr. Jack disappeared but treatment centers up and down the state of California continued to be terrorized by unqualified doctors, mostly psychiatrists, who insurance companies hired to save them money by denying additional days of treatment or dropping residential patients to the more inexpensive outpatient level of care before they were ready. To justify their decisions, they usually cited random treatment guides like MC that had nothing to do with addiction treatment.
On January 1, 2021, State Senator Scott Wiener’s Senate Bill 855 became law in California. It mandated that length of stay in addiction treatment, and level of care, can only be determined by using criteria developed by ASAM, the American Society of Addiction Medicine.
Did insurance companies begin hiring qualified addiction doctors who knew ASAM criteria to do the peer-to-peer reviews? For the most part no. There were slews of new Dr. Jack’s still denying treatment for no reason other than to enrich themselves and save the insurance companies money. Some of them will not give their full names, or their medical expertise, or the state or states in which they are licensed. Some admit they know nothing about addiction.
Many come from Prest & Associates of Wisconsin. Most Prest doctors deny 90-100% of their California reviews. In 2010 the Ninth Circuit Court of Appeals outed Prest’s medical director. They found that United Health Care had improperly “denied benefits and abused its discretion in refusing to pay for treatment” of a mental health patient by relying on “mischaracterizations of the plaintiff’s medical history and condition” as presented by Prest’s medical director. By the way, she (the medical director) still does peer-to-peer reviews of addiction patients in California and regularly denies more than 95% of the time.
I now serve as Executive Director of Summit Estate Recovery Center, a state-licensed treatment center located in Silicon Valley and primarily serving Silicon Valley. We started suffering from these peer-to-peer denials from unqualified doctors at the start of the pandemic. We put together a draft bill.
“Summit invited our State Senator Dave Cortese to visit the inpatient facility and presented to him the problem,” said Summit CEO Sergei Vidov. “He agreed to sponsor the legislation. To document the need for this law, from November 2021 Summit and fifty-eight other California treatment centers have kept score. The results clearly show that dozens of unqualified doctors have denied treatment required by addiction criteria, many as much as 100% of the time. We congratulate Senator Cortese on successfully carrying the legislation that will bring an end to these bad practices.”
According to State Senator Cortese: “There is clear evidence that SB 999 will save lives. Insurance companies arbitrarily denying critical mental health and addiction recovery services to those in need is a practice that we must end once and for all. We can ensure Californians suffering from mental health and substance use disorders have fair access to a full and lasting recovery.” Please urge Governor Newsom to sign SB 999.
There is a sample letter on the website www.friendsofsb999.org or you can write your own. I would like to personally thank our partners in this effort including Hansei Solutions, Billing Solutions, the California Consortium of Addiction Programs and Professionals, the Kennedy Forum, the Steinberg Institute, CSAM, PCI Centers, Davis Health Management, and others.