Now Is Not The Time

By DSelden 04/03/20

I feel like one of those grouchy old men yelling at kids to get off his lawn. But I am a grouchy old man. I’m not usually this way. Yes, I am almost 65 years old and have been involved with providing behavioral healthcare for over 40 years as a licensed independent clinical social worker. Most of the time I feel pretty positive and can see accomplishments: new programs developing, increased acceptance of addictions as a disease, clients in successful recovery.

But sometimes I hit a wall. I spent close to an hour on the phone this morning with people at a private Managed Care Organization, trying to get more insurance units authorized for one of our clients who I will call Nancy. When she was admitted to our Intensive Outpatient Program she was given insurance coverage by the MCO until March 27. The fact that the insurance company believes that 14 weeks of treatment is sufficient for a chronic disease is just the beginning of the fallacy.   Nancy has been working on recovery from alcoholism and major depressive disorder since December in the IOP.

Before the virus, our IOP operated out of a sunny corner of one of our agency’s buildings, Monday through Friday, providing a series of recovery oriented groups from 9AM to 12:30 PM. We emphasize what Johan Hari talks about in his Ted Talk, that connection is the antidote to addiction. Nancy has been using the program to connect well and is growing stronger in her recovery. For two weeks we have been operating virtually, on Zoom, and our little group of about 10 patients continues to connect through our computers and phones. Nancy has also been working with our Medical Director for medications. Nancy is in her late 40’s, a single mother and a nurse at one of the Boston area hospitals. She felt strong enough to return to work just before the virus hit the area. She is now spending a considerable portion of her week at risk of acquiring COVID-19, helping those who are already infected, as well as the other hospital patients.

 Because of her inconsistent schedule and work on the evening shift, she has been attending IOP 2 days per week. The MCO states that IOP must be a minimum of 9 hours per week (3 days per week). Outpatient at this MCO only allows billing for one outpatient group per week. When I raised the issue of customizing care for the unique needs of Nancy, I was told that she had to fit in either one level of care or the other. Instead of receiving $150 per week (About $75 per day for 2 days of IOP), we will only be able to receive $30 per week, payment for one hour of group treatment. Our reimbursement, already absurdly low, is now reduced by 80%.

Nancy has been using her two days per week in IOP well and is connected with our community here. Given her current work situation, anxiety has become more of an issue than previously. It is not clinically indicated to drop her back to just one hour per week at this time. I also do not think she has the financial resources to manage a bill from us. I reviewed Nancy’s situation with our management team, suggesting that she continue her current schedule for the immediate future, because that is what she needs.

Our little family owned agency does not have much in the way of cash resources and some of us are working with reduced or in some cases no pay during the virus situation. The management group all agreed, immediately, that we would continue to support Nancy’s current treatment plan and fund it through a “scholarship” if that was necessary.

We all agreed, without any discussion, that now is not the time to use bureaucratic rules to abandon our colleagues in need. And I say colleagues because it's not "us" and "them" it's "we".



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