Credit: Getty Images.
Imagine this: you’ve provided a service to a person that was requested, approved and paid for. Years later, without warning, the person who hired you comes back to you and says that although they approved the work you did years ago, they should not have had you do the work and now they want their money back.
You would be outraged, right?
This is exactly what is happening right now to addiction health care providers across New York.
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Every day, addiction health care professionals are doing critical work, operating programs that offer life-saving treatment to people who are in desperate need of care. These professionals, like other health care professionals, must pay their staff, pay their bills to keep the lights on, and pay for the costs associated with providing care to people who are dangerously ill.
And like other health care professionals, addiction professionals are paid after a rigorous process that requires the insurance company to do two things: Determine if the person is covered for benefits at the time of treatment, and approve that person’s treatment if it has been determined to be medically necessary.
Yet in the addiction health care sector, insurance companies that have approved and paid for services – services that were determined medically necessary at the time those services were provided — are able to demand repayment from the professionals who provided those approved services — years after those approved services were provided.
One of the worst offenders in the Empire State is the NYS Health Insurance Program (NYSHIP), an insurer contracted to cover health benefits for state employees and their families.
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In one such case, an addiction treatment program was approved by NYSHIP to provide medically necessary services to a confirmed member. The approved member was employed at the time of treatment, but six months after they received treatment, they were fired. Years later, NYSHIP demanded the addiction care provider return payment, because NYSHIP decided to predate the person’s termination to a suspension that occurred before the member’s treatment was approved but while they were still eligible for such services.
Again, there was no dispute that the above person was insured at the time the services were provided. There is no dispute that the services provided were medically necessary and had been authorized by NYSHIP. NYSHIP did not notify the addiction health care program regarding the person’s job status.
And yet, the addiction treatment provider was forced to give the money back — years after the fact, and despite having followed the rules of the insurance company.
This blatantly unfair practice happens all the time, and it must be stopped. Assemblymember David Weprin has introduced legislation (A.9693) to end this practice, which puts addiction treatment professionals in an impossible position. Indeed, some treatment providers are having to consider shuttering their programs at a time when overdose deaths and addiction-related health needs have never been greater.
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This unfair and dangerous practice jeopardizes the addiction care that so many New Yorkers urgently need. The Legislature must act to end it now.
Robert Kent was general counsel at the state Office of Addiction Services and Supports from 2007 to 2020 and served as the general counsel in the White House Office of National Drug Control Policy during the first two years of the Biden-Harris administration.
Commentary: This insurance company tactic is jeopardizing addiction treatment
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15.04.2024
Credit: Getty Images.
Imagine this: you’ve provided a service to a person that was requested, approved and paid for. Years later, without warning, the person who hired you comes back to you and says that although they approved the work you did years ago, they should not have had you do the work and now they want their money back.
You would be outraged, right?
This is exactly what is happening right now to addiction health care providers across New York.
Advertisement
Article continues below this ad
Every day, addiction health care professionals are doing critical work, operating programs that offer life-saving treatment to people who are in desperate need of care. These professionals, like other health care professionals, must pay their staff, pay their bills to keep the lights on, and pay for the costs associated with providing care to people who are dangerously ill.
And like........
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