The Betty Ford West Los Angeles outpatient center now has in-network status among 14 managed care health plans, such as Anthem Blue Cross and Beacon Health Options. It’s a move meant to increase access to services for those who use insurance benefits for treatment, according to Jim Steinhagen, vice president and administrator of the Betty Ford Center.
“It allows us to reach more people than if we had a private-pay model only,” Steinhagen tells Behavioral Healthcare.
Betty Ford has traditionally been a private-pay model, but currently 50% of its residential patients are leveraging health insurance benefits to finance their care. He says with the West Los Angeles outpatient center moving to in-network status, the number could reach as high as 80%.
Working with payers
The administrative burden on treatment centers can be significant, so it’s in the best interest of the provider to be prepared for commercial payer contracting and the required data gathering, for example. Steinhagen says Betty Ford Center has met with payer groups to find ways to streamline the processes for patients when they use their insurance.
“Chalk up the relationship with payers and providers as a responsibility in which both have to develop a business partnership,” he says. “And with that we have to put in place the practices that allow that to be effective and efficient to meet the needs of our stakeholders and policy holders.”
California has been scrutinizing treatment centers in recent months, even filing law suits for what it considers questionable practices in some cases. Likewise, the insurers have created their own special investigation units, looking to identify fraudulent practices among treatment centers that fail to follow regulations or agreed-upon contractual terms.
Steinhagen says it’s unfortunate that there are behavioral health organizations that take liberties with their business practices, especially considering that most treatment centers are working to do the right thing. The result is that the whole industry is ultimately painted with a broad brush before the public, as if no one can be trusted, even though that’s simply not true.
“We welcome the regulatory oversight because we think it’s been lacking in the field,” he says. “And the Betty Ford Center has always held itself to standards above regulatory compliance and holds itself accountable for best practices and accountability for outcomes.”
In addition to Joint Commission accreditation, state and federal authorities should hold the entire industry accountable to produce outcomes, just as they do for any health system in the United States, he says.