The U.S. Congress and many state legislatures have begun to address a national problem by considering legislation to stop unethical alcohol and drug treatment programs from preying on vulnerable individuals and families seeking treatment.
In December, 2017, the U.S. House Committee on Energy and Commerce Subcommittee on Oversight and Investigations began hearing testimony about predatory practices by substance abuse treatment programs. In 2018, New York passed a measure that makes it a crime to offer or to accept any payment from an individual or entity that provides substance abuse treatment services in exchange for patient referrals and admissions.
The predators have taken advantage of the rise in people needing treatment, in large part, due to the national opiate epidemic and the legalization of marijuana in several states. The fact that the Affordable Care Act and Mental Health Parity and Substance Abuse Equity Act prohibit insurance companies from limiting the number of times a person can be treated for alcohol or drug problems has made predatory behavior even more profitable. In 2017, $36 billion was spent on substance abuse treatment, according to the Substance Abuse and Mental Health Services Administration.
Those engaging in this greed-driven predatory behavior find the most desirable patients to be those with generous insurance coverage and out-of-network benefits. Programs work with brokers who refer unwitting patients to programs offering the highest kickback to the broker with little or no concern for the clinical needs of the patient. They exploit and capitalize on a family’s fears and put patients at risk of inappropriate treatment. These practices often cost patients thousands of dollars. Sophisticated on-line, radio, television and telephone approaches are being used by brokers throughout the country.
How can Teamster families avoid being misled and charged exorbitant fees?
It is important that anyone seeking substance abuse treatment through a Trust Fund that participates with either TAP or TARP contact a counselor to discuss treatment options. Both TAP and TARP contract with treatment programs that are “in-panel” and provide quality treatment at either no or minimal cost to the patient. Counselors are experts in making referrals to treatment that will address the specific needs of clients and they are able to explain treatment options as well as the cost (if there is any) of treatment.
Recently, a family decided to send their adult child to an out-of-panel program that promised all expenses would be covered by insurance. After one month in treatment at a cost of over $60,000 the family found out that only 50% of “usual, customary and reasonable” (UCR) costs would be covered. The UCR was determined to be $12,500 for the geographic area where the treatment was provided. The payment by insurance was 50%, of UCR only $6,250, so the family was responsible for $53,750!
If you or a loved one covered by your health insurance is considering alcohol or drug treatment, check with your insurance plan to determine if TAP or TARP services are available. If you are not sure, you can call TAP (800-253-8326) or TARP (800-522-8277) and speak to a counselor who can help you determine how to best access your treatment benefits.