Your Complete Addiction Treatment Billing Guide to New York
Two Health Insurance Companies Make Up Over Half of the Addiction Treatment Billing Landscape in New York
UnitedHealth commands 37.7% of the health insurance market (and counting) in New York state. They’re trailed by Anthem, with 21.6%.
That means that over half of the time, billing departments at addiction treatment centers will be dealing with one of these two “big fish” in New York.
Then there’s the “other guys.” Lifetime Healthcare trails behind these two giants with 9.3%, Cigna with 8.8%, CVS with 8.2%, and a handful of others: Health Now NY, Emblem, MVP, Independent Health Association, CDPHP, each of which has less than 4% of the market.
New York’s Addiction Treatment Reimbursement Rates are Low, But Lawmakers are Beginning to Make Changes
As with most states in the US, New York has very low reimbursement rates for behavioral health care agencies, making the business of providing mental health care and addiction treatment to low income New Yorkers very unprofitable in many cases. This situation is made even worse when non-profits like HealthFirst don’t reimburse their providers or drop them from the network even as outstanding claims are ignored. However, state Lawmakers are working to bring reimbursement rates for addiction treatment services to market rates.
State lawmakers are also attempting to instate fines for insurance payers who don’t respect mental health parity laws, although experts note that few payers will likely ever be held responsible for infractions.
Finally, state lawmakers have begun funneling cash into behavioral health programs for children under 18 in New York. They’re also providing a cost of living adjustment to state agencies that oversee addiction treatment programs in an effort to address the behavioral health staffing crisis.
Understand New York’s Balance Bill Regulations and “No Surprises” Law for Addiction Treatment Services
New York is one of the states in the union that bans balance billing, also known as “surprise bills.” This practice refers to the unexpected bills that sometimes make their way to patients who seek treatment from out of network providers. When patients need emergency mental health or addiction treatment services, they may seek out whatever provider is available first. Sometimes this provider is not necessarily in network with their insurance provider. In these instances, patient payment is often quite high.
New York’s Emergency Medical Services and Surprise Bill Act makes it illegal for providers to offer to waive any part of the deductible, coinsurance or copayment to convince patients to receive medical care out of network. It also requires that providers supply patients with all the financial details of their proposed medical care before that care takes place and can be billed.
For addiction treatment providers, it’s important to understand how this bill - and others like it - operate to ensure compliance.
Billing Insurance for Addiction Treatment in New York is Easier With the Right Team
Are you a group practice that’s considering opening an IOP or PHP program in New York? A private private practice offering boutique addiction treatment? How about a 50, 100, 150 bed residential facility? A robust outpatient program with a fleet of sober living homes to support patient care?
It doesn’t matter what type of addiction treatment program you’re running. If you’re operating in New York, it’s important to understand the complex billing landscape and know how to leverage the state’s increasingly stringent regulations as well as the myriad, ever-shifting payer requirements in order to optimize your revenue cycle.
That’s why at Behave Health, we’ve seen our client’s reimbursement rates soar after outsourcing their billing to our team. Not only is it too easy to make careless mistakes, it’s also time consuming to develop the close one-on-one relationships you’ll need with key players at each of the largest insurance payers. Our team has spent years cultivating these relationships and is ready to leverage this experience for your addiction treatment center as soon as you get started with us.
Running an Addiction Treatment Business in New York? Here’s Some Other Posts from our Blog That You May Find Helpful
How to Start an Addiction Treatment Center in New York
Top 5 Addiction Treatment Diagnosis Codes to Use for URS with Healthfirst Insurance
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