| Opinion
& Essays - Aug, 1992 Issue |
Insurance Non-Reimbursement
For Clinical Services At Licensed Residential Schools: A Paradox?
By Dr. D. Eugene Thorne, Executive Director
Discovery Academy
(801) 374-2121
It has been a curiosity
and frustration to me and many of my colleagues in the field
of adolescent treatment to observe the continuing “refusals”
by many insurance companies to include within their policy
coverage almost identical services provided by or under the
direction of licensed mental health workers at residential
treatment facilities. This situation is particularly baffling
when listening to the litany of complaints from insurance
companies about their rising costs! It appears as though they
are shooting their own feet.
In my experience,
I personally massaged another school’s "program" into qualifying
for JCAH accreditation; this was done with the hope that the
services provided by that school’s professional staff would
qualify its insured-parents’ to receive appropriate reimbursement
for mental health services provided their youngsters.
Reimbursement was
obtained. But, in order for that school to qualify for JCAH,
it had to frequently and “meaninglessly” increase staff and
facilities (and, such increases inevitably followed by increases
in its fees). That school’s fees are now more than double
or triple what they were before JCAH! Now, the insurance carriers
are putting great pressures upon that school (and other similar
schools) to reduce the time of enrollment (as well as fees),
thus compromising the school’s ability to do its job effectively
and “right”.
DISCOVERY ACADEMY,
like many other schools, is consciously trying to keep its
fees as low as feasible. In facilities such as psychiatric
hospitals, JCAH standards are probably useful, maybe even
needed; but, in residential treatment facilities, such as
the ACADEMY, these standards are too often irrelevant and
useless, and, they create cost burdens with no appreciable
“outcome gain” for similar-service-recipients.
Am I alone in believing
that “patients” as well as insurance carriers would often
be better served by longer, more intensive, but less expensive
therapy services which are provided by licensed residential
treatment facilities? Does it seem to others that it is paradoxical
for insurance carriers to demand compliance with standards
(such as those of JCAH) which appear only to increase costs
without any demonstrable increase in outcome effectiveness;
and, then, to refuse to reimburse parents who utilize these
more cost-effective and outcome-effective, licensed, residential
treatment facilities?
(Let’s talk about
this matter of insurance companies apparently insisting on
higher cost programs. I’m sure Dr. Thorne would appreciate
hearing of some of your experiences and/or suggestions of
what might be done, as would I. Letters and essays are welcome
for future issues.) - Lon
Copyright
© 1991, Woodbury Reports, Inc. (This article may be reproduced
without prior approval if the copyright notice and proper
publication and author attribution accompanies the copy.)
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