Alcoholism and Drug Abuse Weekly (ADAW) posted an article that describes the system used by a Florida treatment program to fill beds with insured clients as an out-of-network provider. They want out-of-network admissions because they do not come with managed care restrictions. ADAW describes their approach as “not unusual for the field.”
The fact that virtually all Banyan patients have out-of-network insurance is by design — out-of-network insurance is the best kind from the provider’s point of view, as there are no cost limitations based on contracts. The main referral source is in Illinois, where Tim Ryan operates as Banyan’s Midwest regional outreach coordinator, a full-time salaried position. Ryan told us that he refers people with good insurance to Banyan, because that’s his job.
. . .
The vast majority of patients Ryan, who has no clinical credentials, refers to treatment have no insurance. He has a not-for-profit that, according to Banyan and Ryan, is independent of his work for Banyan, called the Man in Recovery Foundation. Through this, he attracts people who need treatment.
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Ryberg [an industry consultant] grew up in the area of Chicago where Ryan is operating, and got sober there. He has heard about the Man in Recovery Foundation’s “outpatient groups,” which are used as recruiting mechanisms for patients. “In no way, shape or form does the job they do resemble a typical clinical outreach representative in the industry,” he said. “They’re not clinical, and they’re not sending clients to the appropriate level of care based on need. This is predatory.”
The Chicago Tribune ran a similar story months ago:
Ryan heads a Naperville-based nonprofit dedicated to aiding people with drug problems, but he also has a job marketing a $15,000-a-month rehab center in Florida. The line between those roles is blurry to some critics, who say it could create a conflict of interest.
. . .
The for-profit rehab, which opened in 2013, is one of hundreds of treatment centers in the state. Like many others, it follows the so-called “Florida Model,” in which patients receive therapy at a clinic but live in offsite apartments.
The arrangement allows patients to stay much longer than the typical 28 days of inpatient care, said John Lehman of the Florida Association of Recovery Residences. Low costs and substantial insurance reimbursements have turned such treatment centers into a lucrative business, he said, and many market their services far beyond the state’s borders.
That strikes a nerve with some Chicago-area rehabs — “I find it hard to believe that people need to leave this immediate area in order to get very effective and caring service,” said Pete McLenighan of Joliet’s Stepping Stones Treatment Center — but Banyan owner Joe Tuttle said leaving home can be good for someone seeking sobriety.
“We’re selling (the idea of) getting away from your environment,” he said. “If your friends are using, you’ll probably be using, too.”
Since joining Banyan 15 months ago, Ryan said, he has referred more than 100 people there, some of whom he met through his charitable work. Such an arrangement strikes some in the recovery community as problematic.
What’s the consequence of this?
“The sad thing is, someone sees a TV show [Ryan was recently on Steve Harvey] or a video [Ryan has several], and they make that call,” said VanDivier. “It’s an uninformed panic-stricken consumer out there, and that’s what these guys take advantage of.”
John Lehman, president of the Florida Association of Recovery Residences, told ADAW that lack of education among patients and family members is the systemic problem. “They go Google, and boom, they make a decision,” he said. “As an industry of ethical operators across the country, we should be building an infrastructure that supplants their SEO methods and gets them to a site that educates them on the levels of care, on the appropriate care for the individual, how you go about choosing a program,” he said.
That reference to SEO reminds me of this post and a conversation I had with a rep for program that had something like 6 boutique treatment sites and some ridiculous number of websites to market them.
What will the long term consequences be? It’s hard to know for sure, but I’m pretty certain that it will damage the reputation of all treatment providers (residential, in particular), damage the public perception of recovery, and give insurers reason to clamp down sufficiently indiscriminate manner that will make it more difficult for everyone to access higher levels of care.
I don’t know anything about Tim Ryan or Banyan Treatment Center. But, I do know there are a lot of hustlers out there. Many of them are well-intentioned and want to do good and make a little money at the same time. Unfortunately, many of these people, for a variety of reasons (some financial, some personal) end up in ethically troubling places.