AAC says all urine testing is based on a physician order, and all results are reviewed by a medical provider. They say they run confirmation tests on all samples in which the presumptive screen is positive, when the presumptive screen is negative but is expected to be positive and when no presumptive screen is available for the drug being requested by the physician.
“It’s all about the holy dollar,” said Palm Beach County State’s Attorney Dave Aronberg.
Aronberg convened a grand jury to investigate fraud and abuse in Florida’s addiction treatment industry.
He says he doesn’t know of any good reason a facility should conduct seven confirmatory tests in just 30 days.
“It is frustrating because the good providers, the good doctors, the good treatment centers know that you don’t need all this over billing insurance fraud to get someone healthy,” Aronberg said.
AAC told us they base their testing practices on guidelines from the American Society of Addiction Medicine’s best practice recommendations. But ASAM testing guidelines say the routine use of elaborate tests “are harmful not only because they waste valuable resources, but because they do not fit the standards of appropriate clinical care.”
Rachel’s insurance refused to pay for some of her tests, including the expensive confirmatory tests.
A spokesperson for the insurance company issued the following statement:
“Patient privacy laws prevent us from commenting on a specific member’s case. However, as a general matter, we are disappointed as well as concerned whenever any Blue Cross and Blue Shield of Texas member is surprised by an excessive charge for a seemingly routine service or receives services that may not be medically necessary. BCBSTX works hard to protect our members from fraud, waste, and abuse in provider billing practices.
Members who receive medical services that appear unnecessary or have other concerns about excessive billing should report such issues to the number on the back of their ID card.”
It’s not the first time AAC’s billing for drug testing has been questioned.
In New Jersey, Blue Cross/Blue Shield sued AAC, alleging more than $6 Million in over billing for drug tests. That case has since been settled.
Both Rachel and Isom say they knew of no repercussion, if a patient tested positive on any of the drug tests.
AAC said, of the importance of testing:
“All positive results are clinically addressed on an individual basis by the treatment team. Clinical results can include a revision and reconsideration of level of care, revision of the individualized treatment plan including goals and objectives, extension of treatment, or consideration if this placement is the safest and most effective for the client.”
AAC billed Rachel’s insurance $88,000 — nearly $3,000 a day. That’s a lot of money, when you consider that River Oaks alone has 140 patient beds.
“It’s all about getting a ton of money from really sick people who do need help,” Rachel said.
When it’s less expensive to get medications without insurance than with insurance, we need to wonder about what is going on. Health care providers have always had the governments boot on their neck. Sure, sometimes an extreme outlier slips through–but not for long! We need to get price-gouging insurance companies regulated to the degree that doctors are! I hate to think of “single payer” (socialized) medicine, but we spend WAY to much on profit for these companies!
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