Making insurance relationships work; A California center finds it can maintain the integrity of its mission under changing payment realities

Addiction Professional, July-August, 2008 by Mark Willison

Finally, I hired Elena Coyt, a billing and collections expert who previously had established relationships with several insurance company contract managers. By building new relationships with these companies, we increased the potential number of insureds whom we could serve. We also improved our own reimbursement rates for all of our services. With Coyt's business experience, we have been able to reduce our accounts receivable to less than 2% on a budget of $1.7 million.

Being more flexible

As providers we know that one of our responsibilities is to help reduce clients' stress in entering treatment. Offering flexibility in program selection at affordable rates helps accomplish this goal. In California, most insurance companies and health maintenance organizations will cover services for detox and outpatient treatment as well as residential treatment. By offering all of these services, Beacon House increases the opportunity for those with or without insurance to begin their recovery life.

The first step in evaluating a program's suitability for the prospective patient and his/her insurance coverage occurs during assessment. It is only then that a patient is able to determine if treatment at a particular facility is the correct fit and financially manageable. At Beacon House we do this in two ways. First, the intake coordinator, a clinically trained therapist and the first point of contact for all potential patients, conducts a clinical assessment to set the tone and the course of treatment. Second, our medical director at the time of admittance assesses each client for physical capacities and appropriateness for our facility and programs. If our program is appropriate for this individual, a medical treatment plan is developed. The assessment ensures that we admit the very best candidates for recovery and that they are making the best use of their insurance coverage.

If a potential patient is not a good candidate for recovery at your treatment facility, for any reason, respectfully refer them to another.

Once a patient is admitted, a psychologist with advanced credentials in clinical psychopharmacology assesses him/her to determine the most appropriate treatment protocols. With these assessments for appropriateness, admittance, and treatment, the clinical staff is well positioned to help the patient and our treatment coordinator prepare for the patient's utilization reviews.

To address insurers' use of the ASAM criteria and utilization reviews, we found it to be the best practice to have a trained, experienced clinician coordinate the process. At Beacon House we use treatment coordinator Tara McKinney, a licensed marriage and family therapist. She oversees all treatment protocols and reviews every case to be in the best position to advocate the optimum care for our patients.

We have found that by conducting comprehensive and accurate assessments we are better prepared to work with managed care, and managed care is more willing to work with us. The result is that the patient receives the most appropriate treatment and gets the best use of his/her insurance coverage.