Is Cost-Effective Treatment Out There?
Buyer beware.
By Zachary Siegel

Two families in crisis. One has the money to pay for addiction treatment, the other does not. They’re both extraordinarily vulnerable.

“You’ll sell your soul to the devil to save your child,” says Laurie Ruccatano, a New Jersey mom, of finding treatment for her 23-year-old son, Joey.

Laurie estimates she has spent $250,000 over five years to help Joey, who has bounced from rehab to rehab across the country, receiving mostly shoddy treatment for his heroin addiction. The “devil,” to Laurie, takes the form of a smooth-talking rehab operator.

“These people are so good,” she says. “It’s so hard to read between the lines. I think, ‘Oh my God, this person really cares about my child!’ Two days later, I get a call: ‘Your son walked out and I’m keeping your money.’”

Laurie says she couldn’t file formal complaints against some of the places Joey attended, because they had no license to operate in the first place.

Shelby lives in the desert outside Tempe, Arizona. Lacking Laurie’s financial resources, she’s struggling to help her 22-year-old son find treatment. He has overdosed on opioids three times. Last time, in April 2017, landed him on life support. Shelby didn’t know if he’d wake upor, if he did, what kind of damage might be done to his oxygen-starved brain.

Thankfully, he woke up his same old self.

“He has moments where he really sounds like he’s ready to get help,” Shelby says. “But those windows close fast and I’ve never been able to get him into treatment.”

She describes the last few years of trying to help her son, whose insurance doesn’t provide anywhere near adequate coverage, as “beyond frustrating.”

It’s a Minefield

Whether families have resources or not, America’s unregulated addiction treatment market is littered with profiteering, fraud, neglect and abuse. One wrong step can mean falling into a hole of debt, or shuffling in and out of flophouses posing as treatment centers, or both.

Interviews with behavioral health experts, treatment industry veterans and struggling families illustrate how hard it is to find a decent option—one with even a slim chance of a good outcome—without being horribly ripped off.

Sadly, there is no one true path forward. But we can at least identify some red flags to avoid in your search. We can warn you about exploitative practices you’re trying to avoid. We can list the questions you should be asking any provider. And we can take a look at how some families cope.  

Some better-than-average places to look for treatment—if you’ve made sure, preferably with independent professional advice, that you need it—include the Substance Abuse and Mental Health Administration’s treatment locator, or the online resources of an activist group such as Facing Addiction. But there’s still no guarantee that facilities either list are ethical or affordable.

Above all, approach any potential transaction with this in mind: Buyer beware.

Five Red Flags in Your Rehab Search

Most people’s hunt for rehab begins, like most searches nowadays, with Google.

“But if I have a broken leg, am I going to Google: ‘Best broken leg care’? Or ‘best cancer care’?” asks Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers, which aims to increase the availability and quality of addiction treatment. “Are you fucking kidding me? Addiction care is the only health care field where the primary means of finding care is the internet.”

The first thing experts like Ventrell tell people seeking rehab: Don’t trust a Google search. (Thanks to journalism and advocacy, Google has begun to crack down on sketchy rehabs using its search engine for advertising, but the point still stands.)

“Don’t get mixed up with a body broker,”

Ventrell says many of the 1-800 numbers you find on the internet—or those TV ads featuring a bespectacled doctor—are downright deceptive. They’ll ask about your addiction, but really, they want to know about your insurance coverage. “Don’t call that guy on TV wearing a stethoscope, or the 800-number,” he says. “You wouldn’t do that for any other disease.”

Kaitlin*, now 26, Googled rehabs after spending a night in a Dallas jail for public intoxication in November 2016, and became a victim of deceptive advertising.

In the backseat of an Uber, demoralized and shaken after her morning release from jail, Kaitlin called the first 800-number she found. Calling 800-numbers is unwise, according to experts like Brad Lamm, an advocate for ethics in the behavioral health field, because most of the operators are paid per-admission—incentivizing high-pressure, deceptive sales tactics.

Kaitlin described her situation, still periodically blacking out, and gave the person on the line her insurance details. The next day a plane ticket to Florida was purchased in her name and she was off to Awakenings for Women, a treatment facility located in a renovated Boca Raton hotel. Not only was Kaitlin’s plane ticket paid for, but Awakenings offered her free room and board while she attended “intensive-outpatient.”

Inducements or perks—like free rent, plane tickets, or even cigarettes—are often folded into treatment packages. They’re illegal in Florida, under the state’s patient brokering statute. And if they’re offered, that’s a clear sign that the facility is more interested in profits than patients, according to Ventrell.

More broadly, Ventrell says be wary of out-of-state facilities promising luxury: “A beach? A masseuse? A chef? We are way off on this stuff. Addiction is a healthcare issue, so stay the hell home and see if there’s a good treatment program around the corner.”

Several studies show that going away for expensive, 30-to-90-day residential rehab has no clinical benefit over cheaper, outpatient programs. Google’s new advertising policy should make it easier for patients to find facilities locally.

“Don’t get mixed up with a body broker,” Ventrell adds. A “body broker,” otherwise known as a patient broker, funnels prospective clients with insurance policies to rehabs in return for a kickback. “Each recovering addict with a health insurance policy they can nab for a sober home can net these so-called body brokers up to $500,” according to the Palm Beach Post.

For this reason, a good insurance policy can be a double-edged sword. Rehabs place a premium on patients with a “Preferred Provider Organization” policy, because they tend to pay out higher. Kaitlin, for instance, was offered the works because she was young enough to be covered on her mom’s plan. If the policy is out-of-network, the facility can charge even more.

Five Red Flags in Your Rehab Search

  • Don’t trust internet searches
  • Avoid 800-numbers
  • Being offered perks or inducements is a bad sign
  • Be wary of out-of-state programs boasting of luxury
  • Don’t get involved with anyone who gets a kickback for referrals
How Rehabs Milk Vulnerable Families for Cash

Kaitlin lost her premium-patient status in January 2017, when her mom, Sharon, had to switch insurance plans. That’s when the threatening calls started.

Sharon says she received messages from operators at Awakenings, saying, “‘We are not a homeless shelter and if someone doesn’t give me money, we’re throwing her out on the street.” Increasing its leverage, the facility had Sharon’s credit card on file for incidental expenses, like meals and group outings: “They took my credit card and charged me $200 out of nowhere,” says Sharon, who describes the whole episode as “a horror.”

“We were told that his family had an endless supply of money, and we were to do whatever we had to to keep him in the facility.”

Another way for predatory providers to scam vulnerable families is by charging ludicrous fees for drug testing. A Palm Beach Post investigation exposed how rehabs make millions this way; something to look out for in billings.

“They constantly took urine and blood samples for testing,” Sharon says of her daughter Kaitlin. Because Kaitlin was out-of-state, the facility could charge sky-high, out-of-network prices. By Sharon’s estimate, Awakenings charged tens of thousands of dollars in urinalysis alone.

Others have been similarly ripped off—including $10,600 for one test. A 10-pack of testing kits that anyone can use at home costs $22.78 on Amazon.

On top of unnecessary drug tests, patients often report being overmedicated by shady providers to inflate costs and increase control. “They had [Kaitlin] so medicated she was sleeping 15 hours a day,” Sharon says, adding that at one point, her daughter was in such bad shape she was hospitalized for three days.

Overmedication is a pattern found in rehab investigations. One investigation into Recovery Centers of America by STAT News told the story of a patient named Charles: “‘At times it was observed that he was nodding out and appeared overmedicated,’ wrote one fired staff member … ‘We were told that he and his family had an endless supply of money, and we were to do whatever we had to to keep him in the facility.’”

Not long after Kaitlin left Awakenings, Sharon received a phone call from a detective. “I think the he was from the Sober Homes Task Force in Florida,” she says. “I gave him all the information and documents I had about my daughter’s experience.” She’s waiting for Florida to drain the proverbial swamp.

Addiction Retold  has also asked Awakenings for comment on these allegations, and received no response.

Five Questions to Ask a Rehab Before You Agree to Anything

People seeking addiction treatment are at a tremendous disadvantage, acknowledges Marvin Ventrell of the National Association of Addiction Treatment Providers. “If you have diabetes or cancer, you can pretty much trust the local branch of a hospital near you … But addiction treatment is still stigmatized, and not treated and marketed like other health care.”

In this environment, patients and their loved ones must typically figure out for themselves whether to trust a treatment provider they contact. Where to begin?

Brad Lamm knows the field inside-out. The founder and CEO of Change, Inc., he has operated in Southern California’s booming behavioral healthcare industry for decades, and isn’t afraid to blow the whistle on his colleagues. He says: “I challenge every parent or consumer looking for treatment to ask several questions.”

  1. Ask if the provider “buys or sells leads.” The answer could reveal whether you’re dealing with a facility that prioritizes profit over patient care. (Often referred to as “heads for beds,” rehabs paying for referrals is a streamlined version of patient brokering.)
  2. Ask if they offer refunds if a client leaves early—and get that policy in writing. Laurie, the New Jersey mom interviewed for this article, has been burned by places without such a policy. Lamm says facilities that don’t offer such refunds usually care for their bottom line more than their client.
  3. Ask what the day-rate is, and what each day’s treatment schedule looks like. Most treatment centers have a day-rate: Try to compare that rate with schedule. For example, ask how many people there are per group. More than 8-10 people means the facility is probably cramming in clients. Ask how much individual therapy and one-on-one counseling is offered.
  4. Ask what the facility’s standards are. Does each therapist have a master’s-level degree or more? Or do they rely on cheap labor from interns? Are there clinical psychologists and medical doctors on staff?
  5. Finally, ask for details about the substance and quality of the treatment. For example, if they say they provide individual treatment plans, but in fact deploy a 12-step, abstinence-only model for all their patients, then they really don’t provide individual care.
The Leap of Faith: How People Pay—Or Find Another Way

Once consumers are fully aware of the treatment industry’s darker corners, the next question is how to pay. While America debates health-care policies, drug-related fatalities climb unabated. Communities most burdened by addiction and overdose are seeing long wait-lists for publicly funded facilities and often have the fewest treatment options.

Addiction treatment is one of the essential benefits of the Affordable Care Act, which means insurance must cover addiction just as it covers other medical conditions. Yet insurance companies creatively find ways to avoid paying for mental health and addiction treatment.

“It cannot be emphasized strongly enough that going to such lengths to pay for something with a failure-rate this high is extremely risky.”

Shelby’s son is on Arizona’s Medicaid plan, which covers few options, leaving him with little access to quality care. “I’ve tried the Salvation Army but there’s a huge waiting list,” Shelby says.

Experts like Ventrell and Lamm encourage under-resourced families to ask rehabs about scholarships and sliding-scale policies. Some facilities allot a set number of cut-price—or even free—treatment places, though nowhere near enough to meet demand.

But families without insurance typically pay out of pocket, borrowing money from friends or relatives. Some set up crowdfunding page to broadcast their need for help. However, a scan of GoFundMe for addiction treatment services suggests that most campaigns net only a few hundred dollars. Other payment strategies include dipping into personal savings, or borrowing from college or retirement funds. And it’s common for families to take out home equity loans, borrowing money from their mortgage.

Laura*, a Florida woman who advocates for ethical treatment in a state rife with fraud, did this to pay for her son’s treatment. “I took out a home equity loan because I didn’t want to go into my 401k,” she says. “I called it my ‘rehab write-off.’”

Though she doesn’t regret it, she believes the treatment industry needs a structural overhaul.

“I should be guided by a hospital or my primary care doctor for treatment resources,” she says. “Instead, the internet guides people. They click around and don’t know what they’re doing. It’s a scary world. Us parents have to become experts to save our own children.”

It cannot be emphasized strongly enough that going to such lengths to pay for something with a failure-rate as high as addiction treatment is extremely risky—but people’s desperation is easy to understand.

People who are unable to muster the resources to pay, and not lucky enough to find a scholarship place, typically wind up on wait-lists for low-budget, state-funded facilities.

Brooke Feldman entered Philadelphia’s state-funded treatment system in 2005, when she was in her twenties. She had been taking dozens of painkillers daily, and couldn’t go on much longer. “The stars aligned,” she says. She found a publicly funded outpatient program to attend during the day, and a recovery home to sleep in.

She calls it a “huge difference maker,” because these state-funded facilities were regulated, unlike the private sober homes in South Florida. Brooke is now getting her Social Work degree at the University of Pennsylvania, and consults with various publicly funded facilities across the country. “I’m an example of the system working,” she says. “But that was 12 years ago and is not the experience many people have today. For many people the system does not open its doors when someone knocks.”

Feldman recommends that people without resources start by reaching out to their county health department to see if there are references for state-funded facilities. However, “the reality is, a lot of times there is nothing.”

Ventrell echoes that grim conclusion: “If you don’t have resources, I don’t have an answer.”

“They Just See How Much Money They Can Make”

Sharon, Kaitlin’s mom, says her daughter is still trying to get well: At time of writing, she’s enrolled in another outpatient program and living in a sober home.

“She’s beautiful and highly intelligent,” Sharon says. But she adds that because of her drinking and drug use, her daughter has almost no short-term memory, frequently loses her keys and credit cards, and is now on Social Security disability.

“The current treatment system does such a bad job of managing this disease. They just give them meds they don’t need and see how much money they can make off vulnerable people.”

Zachary is a Chicago-based journalist covering drugs, criminal justice and public health. His work has appeared in the New York Times Magazine, Slate, WIRED, New York Magazine, the Daily Beast, VICE, Salon, The Appeal, The Fix, AlterNet and many other publications... read more >>

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