Billing for addiction treatment in Florida doesn’t need to be complicated if you know what you’re doing. In this post, we’ll orient you to the basics of medical billing in Florida and examine the most relevant legislation and regulations for the behavioral health community in the Sunshine State.
Individual Health Insurance Plans Lead the Market Share for Addiction Treatment Payers in Florida
In Florida, there are three types of insurance that addiction treatment patients might have: individual, small group or large group insurance policies. (This doesn’t include, of course, the 2,690,698 uninsured people in Florida, where the percentage of uninsured individuals is over 16% higher than the national average. 12% of Floridians are uninsured.)
Individual insurance refers to insurance that patients purchase by themselves, whereas small and large group insurance refers to the health insurance that employees receive through their employers. Large group insurance refers to employers over 50 people and small group insurance refers to employers under 50 people.
Here’s the Largest Individual Health Insurance Companies Paying Addiction Treatment Insurance Claims in Florida
Florida is considered to be a “highly concentrated” market, which means that there are a few companies that dominate the market.
For individual plans, the top companies are: Guidewell Mutual Holding Group, Centene Corporation Group and Molina Healthcare Inc Group.
Guidewell Mutual Holding Group is a parent company of Florida Blue, which is the largest insurer in Florida with 65% market share. Centene Group trails behind with 27% and the third largest insurer, Molina Healthcare Inc Group, only holds 2% of the market.
Here’s Florida’s Biggest Group Health Insurance Companies for Addiction Treatment Providers
When it comes to large group health plans, the biggest health insurance companies in Florida are: Guidewell Mutual Holding Group (AKA Florida Blue), UnitedHealth and CVS Group.
The numbers in this market are a little more balanced, but Florida Blue still holds 43% of the market. UnitedHealth claims a 24% market share and CVS Group holds a healthy 19%.
Insurance Fraud and Abuse is Rampant in Florida. Here’s What to Know as an Ethical Addiction Treatment Provider
Florida is notorious for exploitative behavioral healthcare and fraudulent addiction treatment insurance billing. The “Florida Model” - which separates treatment from housing - hails from Florida, where the model is often employed unscrupulously. Patient brokering, referral kickbacks, sham treatment centers, telehealth abuses, drug addled “recovery housing,” unscrupulous medical directors and complex out-of-state insurance schemes are the order of the day at some poorly run behavioral health businesses in Florida.
Because of the notoriety of the exploitation taking place in some corners of the Florida addiction treatment community, the government has begun to regulate the industry as a whole more than ever. This affects ethical treatment centers as well as questionable facilities.
There are now many requirements to get your treatment center licensed in the state of Florida, including an “affidavit of character” for the owners. Each application contains several background checks and a lot of documentation about business models and certifications.
Because of increasing levels of state and federal monitoring of the addiction treatment community in Florida, it is especially important that your billing department play strictly by the rules and uphold the best standards of care. Now is not the time for careless errors in your claims. Be sure that you are working with billing professionals who understand the addiction treatment industry and are committed to authoring claims with rigorous integrity strictly according to clinical guidelines.
Florida’s Insurance Billing News: Understanding the “No Surprises” Act in Florida for Addiction Treatment Providers
The latest issue of note in regards to addiction treatment billing is the so-called “No Surprises Act,” just recently put into law in Florida. The No Surprises Act requires providers to give an estimate of costs for prospective patients before any care takes place. The No Surprises Act is designed to prevent giant out-of-network bills that often take patients by surprise. However, many addiction treatment professionals - and mental health clinicians in general - take issue with the bill’s provision for “price transparency.” This provision requires that addiction treatment centers give prospective patients a detailed account of what to expect from their medical bills connected to treatment. This sounds like a great idea, however, in practice it presents some problems for addiction treatment.
The potential problems clinicians are noticing on the ground are:
Diagnosis can change during treatment
Treatment length or level of care may change in response to diagnosis changes or shifting treatment needs that might emerge during treatment
Relapse affects treatment planning
Comorbid conditions may not be identified until after intake and initial assessment is complete
Pre-existing mental health conditions are often misdiagnosed and don’t receive proper diagnosis until treatment is underway
More About Running an Addiction Treatment Center in Florida on Our Blog
How to Open an Addiction Treatment Center in Florida
How to Complete Insurance Registration with Florida Blue for Addiction Treatment Centers
Looking for Help with Behavioral Health Rehab Insurance Billing in Florida? We Can Help.
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