The Insurance Industry's Role in the Opioid Crisis

The opioid crisis continues to rage in the United States, killing almost 40,000 people per year. While communities and legislators rush to adopt policies to fight the epidemic, changes in the insurance industry may be actively making the epidemic worse.

Coverage Restrictions

As physicians and states pass laws to help stop prescription opioid abuse, such as prescription drug monitoring programs, insurance industries still hold up progress in this area. Many payors don’t cover alternative pain treatments that may help people avoid ever using opioids in the first place because they are more expensive than opioid pain medicines. To help physicians prescribe fewer narcotic pain medicines, insurance companies need to consider coverage of evidence-based interdisciplinary pain programs so patients can receive the care they need.

Low Reimbursement

Coverage restrictions on mental health care services and substance abuse treatment also limit access for many patients who require care. Though multiple laws, including the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, are in place to ensure that insurance companies provide coverage of mental health conditions, insurance companies continue to deny substance abuse treatment.

Even if the services are properly covered, many patients have trouble affording the deductible, out-of-pocket max, or prescriptions associated with their care. These high payments may cause patients to avoid seeking treatment or to stop participating in treatment.

Irregularities in payments made to treatment providers are also making it difficult for them to stay in business. Reimbursements have fallen for both in- and out-of-network treatment centers over the past few years, forcing many facilities to close. With fewer addiction treatment centers available to care for patients, many people cannot get the help they need, putting them at risk for overdoses.

Take-Backs and Offsets

Insurance companies are also more frequently demanding refunds for payments they already made, even years in the past (“take-backs”). After performing audits, insurance companies are retroactively denying claims they’ve already paid and demanding that providers pay back that money, which many facilities are unable to do. When a provider doesn’t pay, insurers may withhold payment from current patients as an “offset” to those costs.

These policies place further burden on addiction treatment centers and mental health providers, who are already strained financially. These sorts of policies may force some treatment centers to close, reducing access to substance abuse care in many communities. These policies may also be illegal, though it will take some time for the court system to make that determination.

Insurance companies are in a good position to help fight the opioid crisis, but only if they change their current policies. As legislators work to fight the opioid crisis, it is vital that they further regulate the insurance industry to ensure the focus is not on profits, but on patients.

At Datapro billing, we help addiction treatment centers and mental health facilities navigate ever-changing reimbursement policies and claims denials. We strive to help your facility improve your finances and receive the payments you have earned. Contact us to discuss how you can improve your billing process and bottom line