Drug/Addictin treatment program start up help needed

[QueenAlicia]

 
I have a client that I am assisting with the start up of a drug
 addiction treatment program. The program and providers will be out of
 network. She is a MH provider who already has an established practice.
 
The drug treatment program wants to have acupuncturist and other
 specialty's on board but they do not want to have liability insurance for
 the other providers. These other providers will be subcontractors and
 1099's. The patients would be seen at the providers established
 facilities but the program won't have a designated facility location.
 
The provider is submitting a grant to the state of CA and is setting up
 the program as a prepaid program and the patients would seek
 reimbursement from their insurance carrier.
 
My question is that if this is a prepaid program and if the patient does
 not meet the require amount of visits does the drug treatment program
 have to reimburse the patient their money. Also if anyone has a fee
 schedule for a drug treatment program I would greatly appreciate if you
 would send one to me.
 
Thank you all for your help.
 
Alicia
 

[Michele]

 
My question is that if this is a prepaid program and if the patient does
 not meet the require amount of visits does the drug treatment program
 have to reimburse the patient their money. Also if anyone has a fee
 schedule for a drug treatment program I would greatly appreciate if you
 would send one to me.
 

 

Your question is not really a billing question but more of a legal one.  You are basically asking if the patient pays for services up front that they end up not receiving does the provider have to refund them, right?   I believe it depends on how you set your plan up from the beginning and also make sure thru an attorney that what you have set up is legal.

[QueenAlicia]

Yes, that is correct Michele.  They are setting up a program and everything will be prepaid by the patient and the patient must meet a minimum requirement of sessions in order for the refund to be issued. 

If the subcontractors were to come on board with the program need to carry E& O for them (other provider 1099's)?

[Michele]

I'm not sure if you are asking if you need E&O insurance for the subcontractors or if you are asking if they will be given 1099's.

Sorry it's been a very rough week!

[PMRNC]

If they subcontract you should make sure they have their OWN insurance. I would talk to an attorney on this but I heard even with their own coverage, if they have a problem or get into trouble it can still bring you down... but again, I would talk to an attorney on that to be sure you cover yourself.

 If they will be employee's you would provide the E/O making sure they are covered. You will also want to make sure all your HIPAA associate agreements are in order and you will need to disclose them on yours with your clients.

[QueenAlicia]

It was for having the E&O covering the sub contractors.

I have decided to contact other drug treatments programs to see if they have a prepaid program and how they charge to present it to my provider.