scaWhen asked why they won’t accept help for an addiction, some patients might mention stigmatization or childcare concerns, while others might claim that their addictions simply aren’t serious enough to merit formal treatment. Among all of the reasons patients might cite, however, issues of cost can be paramount. While referring professionals might not be asked to solve these problems for their patients, there are some things they might be expected to do in order to make the complications less acute.
Difficult Payment Structure
Medical providers are adept at traversing the insurance process, and often they’re required to submit very different types of invoices to different agencies, depending on the type of care a patient might need. For example, as an article in Schizophrenia Bulletin points out, patients who have addictions and mental illnesses might face charges that fall under their mental health benefits, as well as charges that fall into the realm of physical care. Some of their needs might not be covered by insurance programs at all.
If this sort of issue is irritating to a provider, it can be out-and-out terrifying for a patient, as this person might envision paying hundreds of thousands of dollars out of pocket for care that is desperately needed, all because bureaucrats don’t seem willing to help. Some patients might stay out of care altogether, simply because they don’t understand what they’ll be required to pay.
Working Through Insurance
Some patients struggle with issues of cost simply because they have no insurance coverage at all, as well as no access to cash that could cover their fees. A study in the journal Health Affairs suggests that this situation was less likely in 2010, when compared to 1999 levels, and it’s possible that health care legislation will make the numbers drop yet further. As a result, providers with patients who have addictions will likely be asked to intercede with an insurance company, as it’s more likely that all patients will have some type of coverage.
These agencies often ask for documentation regarding the need for care. They might ask for:
- Chart notes
- Lab results
- Written statements
- Detailed invoices
Providing all of this information promptly and agreeing to be available if questions arise can help to ensure that patients get the authorization they need in order to enroll in programs that can help.
Asking for Assistance
Addiction treatment facilities are often surprisingly helpful sources of information when it comes to issues of cost. Some programs reduce the fees patients must pay if these patients can demonstrate financial need while others might agree to take payments in installments or otherwise work to make care affordable. Administrators in some facilities are also willing to work directly with a patient’s insurance company, ensuring that all the paperwork is complete before care is provided.
Referring providers might not need to get involved in these steps at all, but they should be certain to explain to their nervous patients that payment concerns can be quickly and readily addressed. Patients may experience real relief, when they hear that they’ll be able to find a way to pay for care, and they might agree to enroll as a result.
Administrators of Foundations Recovery Network programs are happy to discuss these payment concerns with you. In fact, we’re happy to work with insurance companies, as mentioned, and smooth the preauthorization process. Call us to find out more.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton