50% Is The New Norm For Addiction Treatment

By Brent Bevelhymer, LMHC, ICADC, CAP, LPC, MS, Licensed Psychotherapist

Yep, I said it. Truth bomb. I have been in this field for the last 20 years and in recovery as well, and I can say- the field has changed a lot in that time. When I came into the field in early 2000 at Hazelden, I was still hearing stories about the insurance fraud that had occurred in the 80’s from my peers who were around at that time. In early 2000, we were in a position where the providers were much fewer and far between and we had waiting lists, high referral sources, and cash pay clients who were willing to shell out the money for 30 days of treatment or more.

What I recollect, in my opinion, was a very ethical and honest environment that I could be proud of and finally respect myself after years of doing things I would not have normally done in active addiction.

But here we are again, in a similar position of insurance fraud, bad press, and insurance dictated treatment rather than clinically driven treatment. We have a lot of providers that have literally saturated the market in a billion-dollar industry. What’s worse is, the hedge fund guys who are coming in buying multiple facilities with the intent on getting rich quick with very few services, milking the insurance for the client’s lifetime benefits and then getting out quick of the people mill. Those guys and gals have a warm place in hell waiting for them.

What this has created is a very paranoid and suspicious market, both by the insurance carriers, policy holders, referral sources, various providers, and consumers. The consumers- family members who read things like “send your kid to Florida for treatment and have them return in a body bag”, or the referral sources that you have normally done business with have not sent many referrals your way and you end up thinking they are doing business with someone else or you have done something wrong and they are not telling you. Or, better yet, the insurance companies do not want to pay for care because those in the field who have abused and committed insurance fraud have given them plenty of ammo to not compensate for services that are submitted by any and all of us who are legitimate and ethical providers.

Let’s be honest, it’s been like the wild west in South Florida in terms of outpatient centers and sober homes and we were overdue for more regulation and for a lot of these places to be shut down. My question is, how many addicts or alcoholics have suffered from these things and how many people who needed help couldn’t get to good providers that were accessible to them either by location or by economic means because they were swayed away from treatment because of the bad press. My guess is, it’s been a lot.

My cousin who was 29, was in and out of outpatient treatment centers in Oklahoma. My whole family had tried to help her but she accidentally overdosed on methadone at a methadone clinic after she had a short period of time away from opioid use. I truly believe because there were so few providers in her area that she could have benefited greatly from a South Florida provider, but it just wasn’t meant to be and logistically was too difficult at the time. Even myself, a sober person of 19-years from all mood- or mind-altering chemicals would not be sober today or have made it in early sobriety after having a 10k a month cocaine “habit” if it were not for a great treatment center in Florida.

Fifty% census is the norm because we have saturated the market in many areas and in the same referral networks, but new referral sources and entry points are not being utilized. Additionally, the top 2% of the money earners who can afford 25k per month want to use insurance, but the insurance does not want to compensate.

So, this means we have to think outside the box on how we meet those needs as the provider and for the consumers in a cost efficient and safe way. Key word here- being safe, and I would like to add ethical, because you would think that is a given, but sadly, often times it is not. Do we use a hybrid of services that have been used in the past in terms of residential care, Florida model of providing housing and services off site, and intensive outpatient? Do we use short term medically assisted treatment (MAT) and day treatment and strong long-term outpatient services to slowly step a person down? I am not sure there is a clear-cut answer, but I do know each case is different and these are people with a life and death illness that cannot be ignored. I do know that you have to treat a person differently who has been using long term suboxone than someone who has just been smoking pot.

What I want to say is, there is still a lot of good providers who put their blood, sweat and tears into helping other alcoholics and addicts. They are paid very little, with long work hours, and are rarely thanked for their hard work. They do it to see the success stories, the families reunited and for the patients to go on and have families of their own, and enjoy all the fruits of recovery.

As a provider you have to be the best, unique, and do something different that is both cost effective and has positive outcomes, otherwise, you probably won’t be around long or you will be successful for a while and have a terrible reputation. Neither of the latter sound very appealing.

As a family member or potential client, I suggest you go out and investigate where you might be going. It doesn’t matter whether it’s in your home state or the other side of the country- visit unexpectedly, read the reviews and ask multiple clinicians who they have heard has a good reputation for good work. There are plenty of great people out there. What I always say is do the right thing even when no one is looking and your business will be a success as well as your life. We need to operate the same way all the time, regardless of when we have regulatory visits, tours, or marketing events because the best marketing tool is the patients who do well and tell others about their positive experiences.

Brent Bevelhymer is the CEO of Villa Tranquil.
www.villatranquilrecovery.com