It’s true that more Americans than ever before have health insurance. However, some insurers are up to their old tricks, making even more profits by denying basic care for people who suffer from substance use disorders and addiction. High deductibles and no out-of-network benefits are becoming the norm with many plans. Contracted or “in network” treatment providers are pressured by the insurance companies to put patients in IOP (outpatient) too soon, with disastrous results.
Consumers who choose a quality-driven treatment approach verses an insurance-driven one often must be willing to pay substantially out-of-pocket. This is when picking a high-quality center with an advantageous cash rate is wise. Beware of hospital-based and big-box treatment providers which are based on volume and insurance billing. Due to all the overhead expenditures (billing costs, insurance reviewers, auditors, coders and collectors), “the rate is the rate.” They must collect $600 to $1400 per patient day to cover their expenses. That is what is billed to the insurance companies for rehab. If insurance won’t pay (they often do not), the same amount is billed to the consumer. There is no cash rate. And whether they expect to be paid by an insurance check, the family or the patient, at those inflated rates, the pressure is on the first month to get the revenue that is available and move the patient to a low-quality outpatient experience which will be billed at about $250 – $350 per session, at about 3 sessions a week for 4 – 6 weeks. When the tap runs dry on that, the patient is then discharged . . . often to nothing but 12 step meetings.
NIDA guidelines say people need about 90 days in primary treatment for it to be effective. Insurance-driven treatment typically see 8-12 days of inpatient approved by insurance, followed by 4 – 6 weeks of IOP. This is clearly a problem, setting the patient up for relapse. Relapsing after this type of insurance-driven treatment is demoralizing for all and often very costly to the family.
RESEARCH SHOWS: LONGER TREATMENT PRODUCES BETTER RESULTS
Smaller independent centers however have a different approach. Starting with a quality-driven model versus insurance-driven, all aspects are designed to maximize access, engagement and long-term success. Since we know that virtually all patients who are diagnosed with a moderate-to-severe substance use disorder will require a minimum of 90 days of primary treatment (often a combination of inpatient and outpatient with a tapering approach is clinically preferred), the fee structure is set accordingly to facilitate continuity of care for the 90 days, plus aftercare. Having a reasonable cash rate for a 90 day programs integral to the quality-driven approach.
When inquiring about treatment, ask:
- What is your cash rate for a 90-day program?
- May I step-down to outpatient prior to 90 days and will my rate be adjusted accordingly?
- Do you bill insurance?
To find out more about the quality-driven treatment model at BoardPrep Recovery Center, please call 813-600-7929.
Liz Harden, LMHC, CAP, Executive Director
Liz has specialized in treatment of substance use disorders and addiction since 1989. She has been recognized nationally for clinical innovations and program design.