Patients receiving treatment for substance abuse in California are a disgruntled lot because Health Net—an insurance provider that offered the best coverage for addiction treatment—has refused to pay for their treatments anymore. The acrimonious tussle between the insurer and treatment providers has been going on for quite some time now, leaving the patients uncertain of the future of their treatments. Apart from this, every individual treatment provider is facing a loss and is almost on the brink of closure due to unpaid bills.
Hundreds of addiction treatment centers in California are facing a cash crunch because of Health Net. The Woodland Hills insurer suddenly stopped paying treatment facilities in early 2016. Throughout 2015 and 2016, it enforced stringent norms on care providers and asked them to provide lengthy documentation of treatment procedures used for its enrollees, despite the fact that the treatments were offered only after prior authorization from the insurer.
Swept up in “dragnet audit,” as referred to by Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, an organization of treatment providers, there is a severe crisis among addiction treatment centers. Patients are highly dependent on insurers to continue with their treatment and such a reversal by their insurer, especially in the middle of a treatment, spells doom for each one of them.
The health insurer, however, dubs this audit as a blanket investigation in a bid to weed out false claims. They claim that it is a process to verify that all treatment claims were bona fide—something that has not gone down well with either the patients or the treatment providers. Corbin said that it had nothing to do with any fraudulent claims or any individual providers. Everyone came under their lens and had to comply with their new norms. “Even after notifying some centers that they had passed their audit, Health Net paid them only a fraction of what they were owed,” he said. Late payments released by Health Net to a few treatment centers were 20 percent of the actual reimbursements the insurer owed them.
Experts feel that Health Net resorted to coercion to prune its financial results after its acquisition by Centene, an insurance company from St. Louis, in a $6.3-billion deal announced in 2015.
Unjust norms ‘rock the boat’ for treatment providers
The entire spectacle orchestrated by Health Net is now making addiction treatment centers feel choked. It has also created insurmountable problems for policyholders who have family members needing addiction treatment. Both, the gullible patients and treatment centers, are at the receiving end of such an abrupt move by Health Net, hurtling the entire addiction treatment industry into disarray.
The imbroglio could lead to another issue for numerous families combating drug abuse. Since several facilities are outside Health Net’s network, a few can “balance bill” their patients, coming after them for whatever remains unpaid after insurance reimbursements. However, for individuals and families reeling under the burden of addiction, footing bills for tens of thousands of dollars could be difficult.
“It’s not like being balance-billed for a broken leg,” noted Joan Borsten, a former treatment center owner and vice president of the addiction center coalition. “Think of the impact when you’re just getting out of recovery and you’re handed a bill for $30,000.”
Even the California Insurance Department rapped Health Net, stating that the insurer was engaging in dubious practices that were completely unfair and deceptive. The department said that it had received many complaints and had thus, issued a show-cause notice to the insurer in June 2017—warning it of dire consequences, including penalties of up to $10,000 for each violation.
Dealing with addiction
It is never easy living with an addiction. Severe and chronic addictions are always fatal, for which, it is imperative to seek immediate treatment. Addiction treatment is a serious job, which calls for committed intervention programs. Any disruption in the treatment is known to adversely affect the well-being of the patient.
If you have a loved one grappling with an addiction, approach a treatment center in your vicinity right away. Sovereign Health of San Clemente is the leading addiction treatment caregiver in the United States. We offer evidence-based treatment at our state-of-the-art detox treatment centers in California. Call our 24/7 helpline members or chat online for further information on our treatment for detox in California and other states.