Cigna Quits Fla. Exchange, Cites Addiction Treatment Facility Abuses

The Affordable Healthcare Act has been a tremendous blessing for  people who are under insured or uninsured since its 2010 inception. The ACA has especially been of great help to those who are struggling with substance abuse issues since many insurance providers provide partial or full coverage for drug treatment and related services needed for addicts to get clean and sober. With open enrollment for the Health Insurance Marketplace two weeks away, one major insurance company, Cigna Inc., has announced that it will be pulling all their insurance plans from the Florida exchange due to abuses by drug treatment facilities in that state.

Cigna Pulls All Plans from Florida Marketplace

Last Thursday, Cigna Inc. had informed some Florida insurance brokers of their decision to pull all their available plans in the state via email. The Hartford, Connecticut-based health insurance giant told brokers they would be notifying customers through regular mail starting this week of their decision. Officials at Cigna have stated that soaring costs in its Florida plans due to ongoing fraud and abuse is the reason why they have pulled all Florida health care plans from the exchange.

This decision will affect about 30,000 Floridians who had enrolled for Cigna plans through the Marketplace for last year and will apply to plans for the upcoming year. Those who receive coverage from Cigna through Medicare or through an employee group plan will not be affected by this decision. The majority of people who will be affected by this decision live in the Central Florida area, as well as Tampa Bay and coastal Southeastern Florida.

While there is no immediate impact on these customers at the current time, they will have to enroll in health plans through another carrier when they renew their enrollment starting November 1st. This decision only applies to plans that were offered in Florida only and doesn’t affect plans offered by Cigna in other states.

Cheating the System

Like other managed-care companies operating in the Marketplace, Cigna gives financial incentives for customers to stay within its tightest network of healthcare providers. While it is preferred that clients stay within these networks for the best coverage possible, many still offer substantial coverage for treatment if they find a provider outside of the preferred network. In Florida, certain clinics and labs targeted the Florida health exchange plans that offered out-of-network benefits. Among the abusive practices that Cigna discovered where kickbacks these clinics and labs received for referrals and excessive testing.

Perhaps the biggest incidence of fraud cited by Cigna officials regarded the exorbitant fees that were being charged not for therapy or medical care—but for simple screens such as urine tests. Southern Florida has long been the recovery mecca that addicts nationwide have flocked to in order to start a new recovery-based lifestyle. Amidst the eye-catching ads for luxury beachfront drug rehabs and pain-free detox centers, some sober living homes, labs and rehab centers were raking in massive profits from excessive urine screens, and health insurance companies were losing millions of dollars in the process.

In an article that ran this past August on myPalmBeachPost told the story of an out-of-state couple who sent their 23-year-old son to a Palm Beach rehab center for addiction treatment. While the family understood that drug treatment would be expensive, the over $300,000 bill that was sent to them weeks after their son completed treatment was something they didn’t expect—and a majority of that expense was lab work such as urine tests.

Urine testing is a staple of rehab and is normally inexpensive.  Corner drug stores sell $25 tests that will immediately indicate the presence of a wide array of drugs. However, some treatment centers, sober homes and their affiliated labs have charged hundreds of dollars for a similar test. In the same article, it was noted that one lab routinely charged a reported $1,500 for each urine test.

The Real Cost

The deceptive practices and greed of a few rehab centers and their affiliates could cost thousands of Floridians the essential treatment coverage they need to get clean and sober. However, it is encouraging to note that many rehab centers, halfway houses and labs have the addict’s best interest in mind, and many have contacted the FBI and other appropriate authorities regarding questionable practices. Cigna officials have stated this change will only affect plan applications for the upcoming year.

In 2017, Cigna will reintroduce new plans to the Florida marketplace with offering that promise to ensure the highest quality care, as well as having plans that are both affordable and sustainable in the long run for all customers.

Insurance concerns are always a concern when it comes to drug treatment. While these essential services save lives and restore families, drug treatment can be expensive and worries of being underinsured or uninsured can provide too much of a barrier to people who need help the most.

If you have concerns about your insurance coverage, call 1-855-619-8070, to speak with an experienced professional at Drug Treatment Center Finder. We work with the best treatment centers nationwide and will review your current insurance in order to find the best treatment options that best fit your needs.

Call us today and make your recovery a reality!

Staff Writer :