Getting insurance companies to fairly reimburse for services rendered is one of the biggest struggles for many addiction treatment providers today. Between an initial verification of benefits, pre-authorizations, concurrent reviews, and even retrospective reviews, it’s easy to get lost in the insurance authorization labyrinth and spend a lot of your organization's time (and money!) fighting with insurance companies.
Today, we’ll look at 4 easy ways to stop struggling with utilization reviews for addiction treatment so you can start focusing on what matters—providing patients with excellent care!
Step 1 to Struggle-Free Utilization Reviews: Understand the Game
The unfortunate truth is the fewer services an insurance company provides, the more money they make in any given quarter. Insurance companies have a huge incentive for denying coverage to the patients—especially behavioral health patients, like those seeking addiction treatment.
In a May 2019 court case, United Health Group’s United Behavioral Health—the largest provider of behavioral health insurance coverage in the United States—was found to have unfairly denied addiction treatment coverage to thousands of patients. In this precedent-setting case, the judge found that the insurer ignored standards of care around addiction treatment and applied unreasonably restrictive coverage rules to addiction treatment specifically in order to offer competitive plan rates to employers. United Health was forced to change its rules and provide for addiction treatment services but these rulings are not uncommon and many other insurance companies attempt to skirt the rules on medical necessity for drug rehabs.
This is why it’s so vital to always focus on proving medical necessity when interacting with insurance companies. Detailed documentation sometimes isn’t enough—knowing the idiosyncrasies of each insurance company and using that knowledge to your advantage is essential to navigating this tough terrain.
Step 2 to Struggle-Free Utilization Reviews: Stop Trying to DIY
Why keep staff in-house to face off with insurance companies when you don’t have to?
At BehaveHealth, we call the Company Care Manager to get utilization reviews done for you. Our Utilization Review Team is comprised of licensed clinicians and experienced specialists who have relationships with the major insurance companies. They know how to present your patient’s case in the best possible light to underscore medical necessity, getting you and your patients the authorizations you need for the longest time period possible.
Not only that, our billing team is happy to train your clinical staff and work hand-in-hand with your team to get current on all the paperwork that you’ll need to coast through each Utilization Review.
(And don’t forget, we don’t just do Utilization Reviews! We do soup-to-nuts billing for every part of the addiction treatment patient lifecycle—verification of benefits, utilization review, billing and collections, patient responsibility, and insurance coverage denials and appeals. We take it all off your plate and deliver more reimbursements with less hassle.)
Step 3 to Struggle-Free Utilization Reviews: Put the Process on Auto Pilot
It’s so easy to let a patient slip through the cracks and forget to submit progress reviews on time, especially when they are due so frequently for concurrent reviews.
That’s why at BehaveHealth, we deliver automated progress review reminders to staff right in our cloud-based addiction treatment management software program. You’ll never miss a concurrent review deadline again.
We also automate the authorization report delivery so there’s no waiting and wondering about a patient’s insurance status. The reports are available on our system immediately after completion. They include: level of care authorized, number of days authorized, date of next progress review, and care manager analysis. Our Utilization Review Specialists always complete quick authorizations at the highest level of care for the most days possible.
Step 4 to Struggle-Free Utilization Reviews: Bank on a Win-Win Situation for Patients and Insurance Companies
At the end of the day, delivering excellent care to patients is what your business is all about.
With BehaveHealth’s Utilization Review Specialists on your team, your staff is free to focus on healing addiction, your patients are empowered to pursue the treatment they need, and insurance companies are supplied with all the tools they need to authorize excellent care for their patients. It’s a win-win-win.
Why Not Try Our Service For Free?
We would love to give you a grand tour of our services so that you can see how it works for yourself. Imagine what your patient’s revenue cycles would be like without having to hassle with insurance reimbursement mishaps, missteps, and fails. Reach out today for your free trial and see why we’re proud to be the most trusted all-in-one cloud-based software solution for addiction treatment providers.