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Center: Insurance inroads come with challenges

September 13, 2013
by Gary A. Enos, Editor
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As more addiction treatment facilities prepare to initiate relationships with insurance companies under health reform, the co-founder of an Arizona center says opening up more services to the insurance market has come with plenty of ongoing challenges.

Journey Healing Centers, which operates facilities in Scottsdale, Ariz., and Salt Lake City, stated in a news release this month that it can now accept Blue Cross Blue Shield coverage for its intensive outpatient services in Arizona. Journey is seeking to work proactively with insurers, but has definitely noticed a tightening approach by insurance companies over the past year, particularly with residential treatment but also in outpatient care.

“In the last year or so insurance companies are starting to require preauthorization 24 hours before the patient comes in,” Journey Healing Centers co-founder Lisa Lannon said in an interview with Addiction Professional this week. “It’s difficult—sometimes we don’t even know if we have all the correct [patient] information at that point.”

Journey holds direct contracts with only a couple of insurance companies; most of its services still tend to be considered out-of-network. Lannon says Blue Cross would not negotiate rates with the organization, informing it that it would review its existing rates annually.

At about 40% insurance coverage in terms of its overall business at present, Journey has had to enhance its staffing for handling insurance issues. “We used to have a part-time staffer doing this, but now we have a full-time person just on insurance,” says Lannon. That transition occurred just under a year ago.

Blue Cross coverage for outpatient services in Arizona certainly has represented a positive step for improving access to treatment, says Lannon. At the same time, Journey has become accustomed in recent months to stricter requirements from the insurance industry in general. One common refrain has involved having a patient try outpatient services first even if that has resulted in failure in the past.

 “Residential treatment has become a little more difficult,” Lannon says. “Some insurers want people in a detox or hospital setting. We’re also receiving more questions, such as, ‘If the person is married, is the spouse involved in the treatment?’” She theorizes that the parity law and the changes in healthcare under the Affordable Care Act (ACA) are driving much of this.

The news release from Journey pointed out that a critical component of the organization’s mission remains its scholarships for individuals needing residential treatment and lacking resources. That amounted to $300,000 worth of assistance from the organization in 2012.