The Blues call it “Pay to Patient.” Since August 2011 it has been an Anthem and BC/BS national policy to reject Assignments of Benefit and send payment due out-of-network providers directly to the patients, even when the patient had not pre-paid the provider.
“Pay to Patient” has negatively impacted virtually every out-of-network provider in the U.S. but especially addiction treatment providers. Many patients never remit the checks and use the windfall to relapse and die, or fund side addictions like gambling, shopping or lavish spending. Not only are facilities and addiction professionals financially damaged, but the IRS and the State of California lose tax revenue because the Blues do not 1099 the patients.
I have been blogging and meeting with elected officials since February 2012, urging someone, anyone to help outlaw “Blue Cross Checks to addiction treatment patients.” I won the support of then State Senator (now Congressman) Ted Lieu, who fired off a tough letter to Anthem, and Assemblyman Richard Bloom who offered to hold hearings if I could find victims to testify; I asked up and down and state and got no volunteers.
Now finally, thanks to the hard work of American Addiction Centers and our friends at CCAAP State Senator Steven Bradford (D-35th District) has introduced a bill that aims to end “Pay to Patient” for addiction treatment. Senate Bill 636 also includes a much-needed ban on paying compensation or inducement to anyone who refers addiction clients to any person or certified or licensed program.
The first hearing on SB 636, before the Senate Health Committee, is on April 5, 2017. Stampp and I are traveling to Sacramento to make sure the bill passes out of committee. If it does, the next hearing will be before the Judicial Committee in May.
Here is the language of that section of the bill that would ban “Pay to Patient” for addiction treatment.
(a) On and after January 1, 2018, a health insurer shall pay insurance benefits contingent upon, or for expenses incurred on account of, addiction treatment services covered under the health insurance policy to the person or persons having provided the addiction treatment services where that person has qualified for reimbursement by submitting the items and information specified in subdivision (b). The amount of that payment shall not exceed the amount of the benefit covered by the policy. Payment so made shall discharge the insurer’s obligation with respect to the amount so paid.
ATAC is asking all ATAC members to follow this link (and let us know how much money you lost due to BC sending checks to addicts in 2014, 2015 and 2016.
We are also asking you to send letters of support to Senator Bradford and your State Senator before April 5, 2017.