Dear Substance Use Treatment Provider and Other Companies in the Industry:
The following article is a cautionary tale about being organized in how an industry deals with insurers. While Anthem was fined for not addressing client grievances in a timely manner by the Department of Managed Health Care, the lesson is what drove DMHC to act was the fact that subscribers and providers filed grievances. As you know, ATAC has asked your organization to file grievances, now you can see the result of those organizations within our industry that did, as well as of those other providers in other parts of healthcare that were experiencing the same problems. Did you file a complaint with DMHC in 2016 when ATAC requested you to complain?
While ATAC applauds the actions of the Department of Managed Health Care, shouldn't the fact that 70% of denials are eventually overturned be considered an unfair payment pattern as defined by the Health and Safety Code 1371.37? Aren't the denials simply a payment delay tactic?
ATAC will be pursuing further action by the Department of Health Care to ensure that Anthem is held fully accountable for all violations of the Health and Safety Code with respect to their actions.
Please read the entire article:
For those who want to know all the details, here is the actual case:
What do you have to complain about today? Underpayments, lack of timely response to contested claims, or ever-changing coding requirements? You must complain to call attention to issues!
Via NY Times -- By MICHAEL CORKERY
As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.
But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.
This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.
Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.
In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.
For 25 years Insight Treatment Center’s highly regarded drug and alcohol program for teenagers has kept thousands of kids off the streets, out of the legal system, and back to their families to lead healthy and productive lives. Now this valuable program is threatened by health insurance company Health Net’s refusal to pay legitimate insurance claims.
Insight’s doors are on the verge of closing due to Health Net’s failure to pay claims for almost two years.
In 2008, a New Jersey Federal Judge found Health Net guilty of obstruction of justice for using “scorched earth” litigation tactics to avoid admitting they had been underpaying out-of-network providers by using a database purposely skewed in favor of insurance companies. In 2009, the judge accepted Health Net’s offer to settle the case for a record $250 million. Also in 2008, a California judge ordered Health Net to stop the controversial practice of canceling sick policyholders and to pay more than $9 million to a breast cancer patient dropped in the middle of chemotherapy.
The New Jersey Federal Judge believed she had changed the way Health Net would do business but by 2015 Health Net was at it again. The Addiction Treatment Advocacy Coalition (ATAC) believes Health Net’s failure to pay legitimate bills of hundreds of addiction treatment providers since August 2015 is directly related to Health Net’s successful efforts to merge with the Centene Corporation, ranked number 66 on the Fortune 500. If you agree, contact Insurance Commissioner Dave Jones and Attorney General Xavier Becerra. Health Net needs to pay the claims of Insight and other legitimate facilities without further delay.C\
Click here to see the youtube video about the devastation Health Net's dragnet audit has wreaked on Insight Recovery Center, one of California's premiere addiction treatment facilities for teenagers.