Does Blue Cross Fuel Addiction by Sending Payment to Addicts Instead of Treatment Providers?

You are an alcoholic or drug addict in the earliest stages of recovery.  You just finished rehab.  On admission you assigned your insurance benefits to the treatment center.cashing check triumphantly.jpg

Suddenly you get a very big check in the mail from your Blue Cross Health Plan, made out to you.  Obviously the money is intended is for the treatment center.   Do you forward it to the treatment center?  Or do you cash the check and spend the money? 

According to alcohol and drug treatment centers up and down the State of California more often than not, the check leads right back to an expensive drug addiction, or triggers a “secondary” addiction like gambling, shopping or overspending.

Is it possible that Anthem Blue Cross of California, Blue Cross of Hawaii and Blue Cross of Washington State – to name a few --  are unaware that the American Society of Addiction Medicine (ASAM) recently updated their definition of addiction to “chronic brain disease?”

Sending the check intended to pay for treatment to the addict or schizophrenic is not like sending a check to someone who broke a leg.

As a supervisor at Blue Shield put it, whenever a claim comes in with a mental health code the system should automatically direct payment to the provider.

Last year we learned the hard way about payment policy of some of the Blue Crosses.  Our client was Colin (not his real name), 32.  In addition to being addicted to prescription pills, he and his Significant Other were very entitled "big spenders" – designer clothes, first class travel, fine dining.  While in treatment, instead of washing his clothes, Colin sent everything out to be cleaned.

Colin's insurance policy only covered part of the treatment costs, and of course he was broke, so his elderly grandparents borrowed money against their social security and pension payments, and his parents cashed out part of their nest egg. 

When we discovered --  to our horror -- that the local Blue Cross, in accordance with their policies, had issued payment to Colin, we were terrified.   We learned through the family Colin and his Significant Other were on vacation in Mexico.  When the couple got home they quickly deposited the check and told the parents no check had arrived.  When Blue Cross confirmed the check had been cashed, Colin told his parents it was a different check.  The parents were ordered to stop communicating with us.  The Significant Other threatened a law suit and hired a lawyer. Obviously Colin was entitled to a financial reward for having completed 30 days of treatment. Fortunately for us, the lawyer insisted that the proceeds of the check be deposited into his client trust account, and then wired us the money.  

Other rehabs have not been so lucky.  One lost $130,000 when clients made off with payments. 

The patient of another treatment center returned home and to his surprise found several large checks waiting for him. By that time he had lost his job and was collecting unemployment.  He hd bills to pay.  So he made a unilateral decision as to what he thought his treatment was actually worth, and kept the rest for himself.    

There ought to be a law.

Comments (1)

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Jeff Schwartz LCSW - March 1, 2012 7:58 PM

I am CEO a behavioral health utilization management company that deals with behavioral health insurance companies and managed care companies and 3rd party payers on a daily basis. Three of my clients who are licensed drug and alcohol treatment facilities have lost money in exactly the same manner that Joan Borsten speaks of in this article. One patient took the check from Anthem, cashed it and purchased heroin. The following day he was found dead with a needle in his arm. There should be a class action suit against Anthem, as they have ruined many patients and families by their ridiculous policy of sending large sums of money to recovering addicts. They become part of the problem instead of part of the solution. Anthem of California is by far the worst managed care company that I have ever encountered in my 24 years as a licensed therapist and advocate for patient rights and insurance injustices. Anthem has proved to be incompetent in every area that I have ever dealt with them on. It never ceases to amaze me with their total uncaring, arrogant and unwilling attitude towards their members and their contracted and non- contracted treatment facilities. I often wonder why anyone would buy one of their insurance policies and suspect that if they really knew the truth about the company and how it is operated in California, they would run as far away from them as humanly possible. Great big kudos to Joan Borsten for standing up for her patients and speaking out about a company like Anthem who are interested in nothing more than the bottom line and impressing their directors and stock holders at the dire expense of their members who pay dearly every month to hold one of their insurance cards.

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