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The Problem with Insurance Based Alcohol and Drug Rehab Centers







Some of the best quality and most ethically grounded alcohol and drug rehab facilities are those that require payments on behalf of the individual or family. Unfortunately, the mindset of much of the population is that of a bifurcating fallacy where they believe that such an organization must surely be focused on the money and not at all on treatment. Which would mean that insurance based programs would in turn be the exact opposite. The reality is that insurance companies do not pay for behavioral health as they do for other services in the healthcare industry. What does this mean for the individual in need of alcohol or drug addiction treatment?

Insurance dictates an individual's care and services and so too their needs. How does this seem best for the individual in need of care who is ultimately attempting to gain control of their life? It is not best for the client and the individual's needs and circumstances should be the primary determinant of what care is provided. That is why many of the top level addiction treatment centers require private payment versus insurance payment. But this does not mean that insurance reimbursement stops here.

Those that do utilize private payment to ensure the highest level of treatment available are still providers, they just happen to be out-of-network for many plans. Reimbursement is still possible for programs that are out of a plans network and facilities do bill insurance on behalf of the individual to attempt to get them reimbursed for much of the costs.

You have heard the age old saying, "you get what you pay for". Well, the alcohol and drug treatment industry is no different. Believe it or not profit driven organizations can actually provide unparalleled levels of care because competition drives quality and profit driven organizations are able to retain the services of some of the best therapists and practitioners available. But again, many individuals falsely believe that an organization that is profit driven cannot possibly put patient care at the epicenter of the organization. But for a second think about this…

An ethical and well managed organization has ethical obligations in three places, its owners or stakeholders, its employees, and most importantly its clients. These things do work together though you might believe otherwise. A mission statement and code of ethics drives an organization and this is the foundation of what they do. A transparent mission statement is as good as words out of the mouths of the owners. Therefore if an organization states that patient care is at the core of their program but are also a for profit entity they can only engage in the latter if they are excelling at the core mission. What is meant is there cannot be conflict in these various obligations. So at no point can anything have precedence over patient care.

As an example, let us look at experiences of this author. Assume that an organization has a 10% margin for all the services it provides. The organization clearly states that patient care is at the core of their program. So if business starts to pick-up and the organization is doing very well, this organization would maintain a 10% margin and utilize any surplus to increase the quality of care and program provided. In this way profit driven organizations are actually beneficial to the care of clients.

Here is the key point, whether an organization takes insurance or not they all must operate, cover overhead, et cetera. Where a private pay organization can charge for the services needed an organization who in primarily reimbursed through insurance must build the program around those benefits. This seems like a poor situation to be in when one's life is at stake. It is time we start looking outside the belt-fed views that so many individual's hold and see the reality of the situation. There is actually something pretty powerful about this model.

It is important to note that not all individuals are fortunate enough to have the financial resources to obtain the services of some of these organizations, but they are much more reasonable than you might think; especially if these organizations are grounded by an ethical existence as mentioned previously. For those individuals that cannot afford such a program there is nothing wrong with the alternative. The purpose of this article is merely to better inform the alcohol and/or drug rehab seeker in their decision making process. Remember, that the program you choose might be the biggest investment in your life; don't underestimate your worth.


About Author Scott McKinney, MS :

Scott McKinney is the Vice President at Midwest Institute for Addiction; a state liscensed medically assisted treatment center in St. Louis, Missouri. MIA is committed to providing quality treatment.
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Article Added on Monday, May 19, 2014
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