CEASE the PAY to PATIENT Model

This can help save lives.

In an effort to discourage providers of SUD treatment from taking out of network policies AND encourage the patient to seek in-network care, many Blue products such as Blue Cross Federal, BCBS of PA, GA, KY, NY CA which are Anthem products, have chosen to implement and endorse a Pay-to-Patient model. This policy is in place to discourage patients from seeking out of network treatment and to divert them to local care which may be inadequate and / or inferior as well as a have a long waiting list. This has produced and will continue to produce tragic outcomes.

Substance Abuse Billing Mistakes

In this situation, the patient receives a check for several thousand dollars or more depending on the length and type of care. Instead of turning the checks over to the treatment center, the patient keeps it, cashes it, and uses it to buy drugs and alcohol. Last month this scenario cost one of our center’s patients their life. A 26-year old male received a check for $20,172.37 from the insurance company and went on a drug fueled rampage, used heroin laced with fentanyl, overdosed and died. This is not an isolated story.

There are many substance abuse billing mistakes that are leaving 20% of earned revenue on the table for drug rehabs. The pay to pateint model is happening 100’s of times a day in these states that refuse to accept an assignment of benefits which would allow the insurance company to send the payment to the provider or facility.

I am advocating that insurance companies do not send reimbursements for treatment services to the patient or the member but rather send directly to the provider of the service.

This can help save lives.