ADDICTION: INSURANCE COMPANIES

I had an interesting interaction with an insurance company last week that has been staying on my mind. With all the talk going on right now about health reform, I would like to run this by you with the hopes of getting some of your experiences, feedback, and general thoughts about how insurance is allocated for addiction. I would like to qualify that I work and live in Oregon; I believe each state makes up their own rules as they go along---now, I could be wrong about this, too.

My (ten year) practice was actually built on not accepting insurance; I have a sliding scale that has worked for my clients, as well as for me. As an addiction counselor I wanted to be sure that clients that came to me had total confidentiality. When anyone signs a release for a vendor to bill their insurance, they are signing a release that the insurance can request any and all of your records. I believe that this is not only a violation of someone’s privacy, it also limits people accessing help for early addiction help for fear of repercussions with their work, family, and societal standing. In addition, when a counselor/therapist is “approved to be on a panel” (someone approved as a “preferred provider”) the insurance company basically dictates how to keep records.

Another reason I did not want to consider taking insurance is the enormous amount of extra work it takes just to bill the insurance and keep the necessary documentation in order to get paid. Taking insurance would mean hiring someone to deal with the insurances; for a small office, this is not financially feasible. It would cost me almost $1000 per week (salary, benefits, taxes, office space) to hire someone to do this job. I would have to see a lot of clients to cover this cost.

My clients often send a paid invoice for services they received to their insurance company for reimbursement. Surprisingly, many of them have received checks covering a portion, or all of what they paid out. There is one insurance company in Oregon, however, that won’t reimburse, and this is the incident I want to share with you: My client had sent in a paid invoice for services she received over a couple months. She received a rejection for payment. She called the insurance company, but they would not budge on their decision. She called me with a number to call to speak to someone on her behalf. The initial person I talked with was a claims representative with a scripted answer; I asked to speak to a supervisor. The supervisor I spoke with was very adamant that their insurance company only paid “licensed therapists” (Licensed Clinical Social Workers-LCSW). I pointed out that “licensed therapist” were, for the most part, not certified in addiction counseling, and not even required to have taken education in addiction counseling. She held her ground saying “You have to be licensed to be paid by insurance.” I then pointed out that Oregon required “certification” and went over what it took to get a certification from the State of Oregon—the hours, the hands on experience, the education, the case presentation, the continued education hours—“That doesn’t make you a licensed therapist” she responded. I protested “But I have more education about addiction then the usual licensed therapist.” She repeated her mantra “You are not a licensed therapist.” I was frustrated. I took a deep breath, then asked “You are an LCSW, aren’t you?” “Yes.” She answered. Our conversation was over.

Here is what I am looking for from addiction professionals and LCSWs: What are the standards set forth in addiction education for LCSWs? How were professional addiction counselors left out of insurance reimbursement opportunities? How can this be changed? Do we want to change it? What can the insurance companies really request from a client’s files? What is going on in the addiction profession in other states as far as billing insurance, certification, and licensing?

If you can answer any of these questions, or shed additional light on this subject, I would be most appreciative. Meanwhile, I will be do research of my own to see if this topic needs to be part of the present movement for changing how health care is delivered.

Learn more about me, MAx Fabry, at

http://www.lifestylechangescounseling.com