A Sinister Insurance Company Trick That’s Dangerous for Everyone
Sometimes it seems like insurance companies will do anything to avoid paying doctors their due. If they have to destroy lives, they’ll do it. And in one particularly dangerous maneuver, that is exactly what is happening.
Lately, Claim Resolutions has been working with a number of drug rehab centers. If you run a drug rehab center of your own, this situation may even sound very familiar to you. Insurance companies have stopped paying the rehab center in favor of cutting checks directly to patients instead. The patients are then on the hook for paying the insurance company, but that almost never happens.
Ages 18-25, struggles with drug addiction and impulse control, $75,000 check…what could possibly go wrong?
These are young people who in most cases aren’t even the ones paying the bills or providing the insurance policy. That would usually be the parents, but the parents aren’t the ones getting the checks either.
In fact, this particular “payment policy” has resulted in mothers calling the rehab facility in a panic because their kid suddenly bought themselves a car, took off into parts unknown and have gotten right back on drugs.
So, to recap: the kid is back on drugs, the money is gone, the patient is now on the hook for insurance fraud, and the doctor is broke. Did the insurance company truly expect any other outcome? Of course not, but they can tell the insurance commission they have a “paid claim” now, that the patient got treatment and that none of this is their fault. Meanwhile, the doctors have done the work. Usually when you do work you get paid for it, but that’s not the reality for thousands of doctors across America.
People who show up for drug rehab need serious care. They can’t wait 12-24 hours to do an intake assessment. Treatment must happen long before anyone gets an insurance agent on the phone. If doctors are going to help these patients at all they have to start right away.
The insurance companies are actually fine with this. They want the doctor to go right on ahead and treat the patient. Untreated patients create PR problems for insurance companies. They don’t want patients going to the press saying the insurance company has kept them from getting the care they need.
Doctors, unfortunately, can’t go to the press to say they haven’t gotten paid. Public opinion just isn’t on the side of the doctors. People tend to assume every doctor is rich, and they don’t realize how badly the doctors are struggling to keep their facilities open.
Regardless of public opinion, obviously, if you do the work (and this is hard work) you deserve to get paid for it.
Why do insurance companies do this? If they were going to cut a check at all, why not cut a check to the right people?
In many cases, the insurance companies are trying to set rehab doctors up for failure. They want the facilities to turn their patients away next time so they don’t have to worry about paying the claim. They can keep collecting ever-increasing premiums without doing anything in return. They know they can keep fooling people into thinking they provide a good service almost indefinitely.
Destroying a few lives for plausible deniability? Must seem like a small price to pay, or they wouldn’t do it.
So why don’t rehab centers just go in-network?
Short answer? It’s not feasible. Going in-network means insurance companies can stop doctors from treating their patients at all. Staying out-of-network is the only way a rehab center can typically do their jobs.
What can a rehab center do instead?
If you run a rehab center that’s locked into this particular nightmare scenario know that we can help. We specialize in getting insurance companies to cut checks for doctors, and not to patients who will be all too tempted to spend the largest check they’ve ever seen. Call us to get immediate help. We value the service you provide and want to help you keep your doors open rather than succumb to insurance company game playing.