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Medical Billing for Drug Screening via Treatment Centers

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Hello, I have been trying to figure out if my sober living is operating legally and was wondering if someone can help me understand there operation. I recently moved into a sober living for the reason that I had some friends that lived there and only have about 7 months sober. The place charges a monthly rent but also uses your insurance to pay for drug tests. Me and my friends all had to see a doctor before coming in and send them our insurance information. They drug test three times a week and bill the insurance companies around $3,000 to $5,500 for each drug test and the insurance company pay out around 4/5ths of what there asking. The place is located in California but the urine is being screened in Florida. My questions are who is getting paid for these tests? what is the reason that they would be Fedexing the tests to Florida when there are my urine screen analysis companies in California? what kind of accreditations do you need to receive these pay outs? If just seems like something fishy is going on , the place i am at houses around 20 guys and would be getting paid well over a million dollars a month from insurance companies if there the ones who are getting these pay outs, and being that the place is a absolute dump it just doesn't make any sense to me. Can someone please help me understand how this process works. Thank you. If this is the wrong place to ask these kind of questions I apologize but I need to understand how this works. Thanks again.

I have not heard of this type of set up.  Do you pay rent to live there?  What exactly are they charging the insurance company?  Room & board?  Or strictly urine tests?  $3,000 - $5,500 sounds high for simply urine tests.  It's really impossible to help though without more specific information.  If it were me I would start by contacting my insurance carrier and asking what exactly is being billed to them from the facility.

To answer your questions I pay $850 a month rent, they are billing my insurance company $4800 for one urine screen and are the allowed paid is $3600. The rent covers a room and a bed and and end table thats about it. More than anything I want to understand how the process works for billing insurance companies for urine screens. Does the business get paid? do they actually see the full $3600? The whole thing is extremely confusing.

We do bill for urine screens for a couple of providers but there are different types of urine screens.  I have never billed for or seen a urine screen for $4800.  That doesn't mean there isn't one, but I have never heard of it.  That is why I would contact the insurance carrier and ask what exactly they are billing for.  Insurance carriers have reasonable and customary amounts that they use when paying for services.  So if they are being paid $3600 then the allowable amount must be up there.  That is why I'm questioning if it is a urine screen that is being billed.  That sounds more like room and board.

Although I do not work in a Sober Living Facility, I do work for an outpatient addictions treatment facility that does urine testing regularly on clients in treatment.  We Fed Ex the urine samples to a California lab twice weekly (we are located on the east coast). The lab in California then bills and accepts the payments from the client's insurance company for the urinalysis. So, to me, it does not sound as if your Sober Living Facility is profiting from these urinalysis.  As far as the amounts charged by the lab for the urinalysis, I have heard from clients about REALLY high fees, high enough to make it hard to believe but, as Michele suggested, these are questions best answered by your insurance carrier.


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