An Arizona nonprofit focused on newborn babies exposed to addictive substances had a large insurer come back for its reimbursement after paying the nonprofit five years ago. The case highlights difficulties nonprofits can face when it comes to being reimbursed.
Jacob’s Hope has cared for 100 newborns with opioid withdrawal symptoms since it cared for its first baby in 2019.
Whether it’s the drug rehabilitation programs they refer mothers to, to the babies they help in their nursery, their support stretches beyond the newborn and into the family.
“We're based on other inpatient facilities, not specifically for infants, so that rate is not really comparable for the services that we provide,” Lyndsey Steele said, the associate director of Jacob’s Hope.
She said depending on the number of babies Jacob’s Hope has under their care, the services they provide can cost them anywhere between $1,200 to $2,400 per day, but the daily rate they’re reimbursed is significantly lower.
Jo Jones, the founder and CEO of Jacob’s Hope, says that no matter the cost, her organization must provide these services.
“The babies need it. The moms need us. We need to be here,” Jones said.
She says they’re supported by private donations, volunteers and reimbursements from Medicaid insurers, which the vast majority of clients at Jacob’s Hope utilize.
But throughout many years of their operation, getting reimbursed has often turned into a challenge.
Numerous Medicaid insurers reimburse Jacob’s Hope for the services they provide to infants.
Those insurers include groups like Health Choice and UnitedHealthcare.
Both insurers have either demanded money be returned or denied payments to Jacob’s Hope, Jones said.
In just the last three years, that’s meant the organization missing out on tens of thousands of dollars.
“We will take those babies knowing we won’t get paid. We’re not going to turn them away,” Jones said.
This year, Jacob’s Hope was forced to return money to Health Choice in what’s called recoupment. A baby’s weight was labeled in pounds instead of grams, Jones said, which is the wrong measurement for billing.
That case the company recouped money from is almost five years old, and Health Choice recouped the money without warning, Jones said.
Health Choice did end up reimbursing Jacob’s Hope recently, and the company said recoupment is required to recover funds due to instances like inaccurate billing.
In the case of UnitedHealthcare, Jones said Jacob’s Hope must request approval for admittance from the company when the infant is transferred from the hospital and cared for at their facility.
But the company denies the authorization if the baby spends any time in a neonatal intensive care unit (NICU) or 48-96 hours in the hospital depending on the type of birth, Jones added.
This means when the mother arrives at Jacob’s Hope, UnitedHealthcare won’t reimburse the organization for the several days worth of services they provide, Jones said.
“We’ve had this happen: the nursery at the hospital is full, so they’ll pop the baby over into the NICU, not for NICU care, but for a bed, because they don’t have room in the nursery,” Jones said.
UnitedHealthcare recommended that KJZZ News talk to AHCCCS, Arizona’s Medicaid agency.
AHCCCS in turn said to speak with the insurer on reimbursements.
Ashley Grant is one of the mothers Jacob’s Hope recently cared for.
She was eight years sober before coming back to Arizona. In October last year, she relapsed, and five days after her partner was incarcerated, she found out she was pregnant.
“There’s not even words that really describe how isolated and how shameful you feel,” Grant said.
She wanted to fight for her baby, but that also meant a fight against people's judgment.
"Just even walking down the street or into the methadone clinic ... I hate to say it, my family just looked at me like I was a piece of s—t,” Grant said.
She was hesitant to ask for help but chose to take a chance.
She said Jacob’s Hope never looked at her like a bad mom.
“I'd probably be on the streets. I would probably have lost my child for good. I probably would have given up,” Grant said.
Moms like Grant will spend an average of 10 days at Jacob’s Hope receiving 24-hour care.
ASU professor Peter Torres, who studies policy that addresses opioid related issues, says the billing errors complicating reimbursements are a clear example of red tape.
“I mean, if it’s an issue of converting the weight of an infant from the metric system to the imperial system, you can definitely, easily ask that question to Siri or Alexa," Torres said.
Caring for a baby inside Jacob’s Hope is Vanessa Petrosyan. She was born with opioid withdrawal symptoms, and she became a nursing assistant at Jacob’s Hope one year ago.
“I just wanted to give back, because I know what these babies are going to face when they get older,” Petrosyan said.
Petroysan said that while working in the ER, she saw moms suffering from addiction being judged and treated differently.
“Honestly, I don’t know why we don’t have more facilities like this and why we’re not flooded with more babies here at Jacob’s Hope," Petroysan said.
Leanna Helsdingen was a mother under the care of Jacob's Hope in October. She looks at the help from the organization as an opportunity to demonstrate she wants to be the best mom she can be.
“I’m just grateful for them," Helsdingern said.
