I came across this article today, and I was pleased to see one of the leaders in our industry talking about the various problems we need to overcome in the addiction rehabilitation industry. The problems we face are grave, as these problems are making it more difficult for those seeking help with addiction to receive the treatment they need.
Mixed Motives in the Addiction Rehabilitation Industry
Instead, there has been a rising tide of treatment facilities and referral services using unethical practices to make money off the Affordable Care Act’s addiction coverage requirements. The author of the article, Rebecca Flood states, “Some new centers are waiving co-pays and deductibles, not charging for sober-living rent and engaging in patient brokering by creating call centers and illegitimate websites.”
These types of activities are all geared with one purpose: chasing insurance money. These tactics are all employed with the motive of getting individuals with insurance benefit plans into a center or program to take advantage of what insurance will reimburse for, and fail to focus on providing what the client actually needs. These tactics unnecessarily victimize those who need help to get their health and life back on track.
Insurance companies are part of the problem
When Rebecca discusses, “bad insurance carriers, who simply deny access to care and find new ways of limiting a benefit that a person has every right to access,” it reminds me of the shrinking amount of time we see being authorized by all carriers for residential and inpatient care at our facility. I cannot speak to the motive of the insurance companies, but it seems they prefer to incentivize providers to offer lower cost outpatient services and urine drug screen analysis even when the patient’s needs require quality residential care.
How do we solve the problem?
I agree with Rebecca. The solution is not to get caught up in the problem, but rather to stay solution oriented. I am happy to join with Rebecca’s suggestion to “create pods of providers, legislators, insurance carriers and community members to work collaboratively for a solution.” California is not the only state in need of reform. This is a national problem.
I also know the system can work slowly, and therefore have another solution to offer. We need to start educating the consumers of the services our industry provides. Far too often in my capacity as an Admission Director, I talk with a potential client or family seeking help for a loved one. They do not yet understand what level of care is needed, or what their insurance will cover. Only a small minority understand how insurance authorizes time or the process of utilization review.
Consumers in our industry also need to be educated to know how to identify if they are talking to someone at a call center that is unaffiliated with a treatment center, and who is selling that lead to someone else. Sales are the priority for these call centers, not the quality of care.
As healthcare providers, our first question to a potential client should not be “what type of insurance do you have,” but rather “how can I help, please tell me what the problem is?” When admissions and referral departments have a full understanding of the problem, they can offer better solutions to the person seeking services. Additionally, they can work with the client to educate them on what insurance will cover and how to work with their insurance company to get coverage for the services needed.
Empower the consumer
I also encourage clients to talk to their insurance provider early, and often, regarding the level of care they are receiving and length of time covered. I believe that if our industry collectively employed the same effort currently expended towards “creative” insurance billing, into educating the consumers of our services, that the dividends would be equally rewarding. Insurance companies need to hear it every day, multiple times a day, from those individuals they serve that what is offered is not enough.
I am perpetually astonished at the sheer volume of decisions made by insurance companies regarding the length of stay or level of care. These decisions are made without any input from the client. We can educate clients so they can better talk to the clinical and medical reviewers that issue denials at the insurance company. We can empower the client and families to advocate for themselves.
Requirement standards for treatment already exist
We have an increasing wealth of research available to our industry now that speaks to what is necessary to treat substance use disorders successfully. The National Institute on Drug Abuse in its publication, “Thirteen Principles of Effective Drug Treatment” states “for most patients, the threshold of significant improvement is reached at about 3 months in treatment,” and that “additional treatment can produce further progress. Programs should include strategies to prevent patients from leaving treatment prematurely.” Unfortunately, insurance companies often act counter to these recommendations.
State medical boards, commercial airlines, and state drug courts all recognize that successful addiction treatment requires a long-term approach that frequently begins with inpatient care. These agencies have all been treating addiction with a long-term approach for quite some time now.
Supporting lifelong sobriety
If our goal is to truly guide and support addicts in lifetime sobriety, educating the public and our politicians pays off. It is of critical importance for consumers to understand the need for longer treatment. Education will encourage the public to start asking the important questions of service providers, insurance companies, and elected officials.
Why is it so often the case that insurance companies only authorize short-term acute care, sometimes as little as two weeks? When longer-term care is authorized, why is it usually only at lower levels of outpatient care?
An informed consumer is the best resource to be asking these questions. The power for change rests with the public. Our role, as members of the industry, is to educate people to facilitate the systematic changes required to truly heal those fighting addiction.
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