A 32-year-old patient in a Las Vegas addiction treatment center was discharged after just four days when her insurer, UnitedHealthcare Health Plan of Nevada Medicaid (HPN), denied additional days of residential treatment. According to her mother, Terry, the patient said she knew she would relapse if forced to leave early.
Virtue Recovery Centers and CrossRoads of Southern Nevada, two major addiction treatment providers with HPN contracts, say the insurer began denying or reducing services in late 2023 at a dangerous pace. Tony Renello, an executive with Virtue Recovery, stated that the center received denials “left and right for no reason” and that HPN required chart audits “for no reason.” He claimed the insurer was focused on profits rather than patient care: “They’re not there to take care of people at all. They’re there for profits.”
HPN countered that the allegations were “unfounded,” saying its “focus remains on providing access to quality, evidence-based behavioral health care for our members in optimal care settings that are compliant with state and federal rules.” The company reported paying roughly 90 percent of claims upon submission. Nevada’s Medicaid division declined to comment, citing state law protecting information obtained during investigations of service providers, but stated it “has not had a contractual reason to issue any sanctions or penalties” to any managed-care organizations.
Denial Patterns and Treatment Impacts
According to legal counsel for Virtue Recovery, during the first three quarters of 2023, HPN routinely authorized 20 days or more for detox and residential treatment. By March 2024, the average length of stay had plummeted to 5.6 days. An attorney representing Virtue Recovery wrote that this amount of time is “not sufficient to appropriately treat HPN members for SUD (substance use disorder). It is, frankly, dangerous.”
Treatment centers said HPN directed Medicaid clients to outpatient clinics and homeless shelters instead of inpatient care. Jeff Iverson, CEO of CrossRoads, said the insurer began denying detox services entirely, directing individuals to emergency rooms instead. Virtue Recovery was forced to close a center it had opened to serve HPN Medicaid clients.
Scope of Medicaid Business
Health Plan of Nevada and three other managed-care organizations hold multiyear contracts worth a combined $11 billion to cover the health care of more than 800,000 Medicaid recipients in Nevada’s urban counties of Clark and Washoe. In fiscal 2024, HPN had the largest share of the managed-care market, covering nearly 280,000 Medicaid beneficiaries and receiving $867.7 million in Medicaid payments.
Drug overdose deaths in Nevada climbed by 11 percent over the prior year to an estimated 1,546 by the end of August 2024, according to the Centers for Disease Control and Prevention. The dismissal of former CEO Don Giancursio and his replacement by Kim Sonerholm marked the beginning of the increased treatment denials, according to treatment center leadership.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.reviewjournal.com/investigations/it-is-frankly-dangerous-addiction-treatment-centers-claim-insurance-denials-have-increased-3310570/