Preparing to Look for Treatment Providers

While working in the field of mental health and substance use, I have seen and learned so much. The fact that our motto is “Doing the right things for the right reasons” should raise an eyebrow to the individual trying to find treatment or a family member trying to help a loved one.

As this industry grows, the field of healthcare is constantly changing. What A/D does is try to be as accessible and affordable to the community. One thing that Mike Dusoe has said is; ” Continue to do the next right thing and everything will fall into place.” When searching for a provider or facility there are a few things to look for.

1. Are they fully licensed?

Each state has their own requirements as far as licensing. It is always a safe bet to check what the requirements are for your state.

First, check the individual provider you are seeing. Whether they be a SUDC (Substance Use Disorder Counselor), CMHC (Clinical Mental Health Counselor), or a LCSW (Licensed Clinical Social Worker).

You can look up there licence through the website below.

http://www.dopl.utah.gov/

Second, check to see that the facility itself is licensed. Inpatient facilities to outpatient facilities need to be licensed and credentialed with the state. INCLUDING SOBER LIVINGS (Utah).

You can search by name of facility through website below.

Home

2. Know Your Insurance.

It does not take long to find out that quality treatment can sometimes cost quite a bit of money. Thanks to the Parity Laws initiated in the Affordable Care Act treatment is now a covered service through almost all insurance plans making it very affordable.

  • Know about your deductible.
    • Deductible is the money you as the insured need to pay before your insurance kicks in and begins to cover services. (ex. $500 deductible means you pay $500 dollars.)
    • Be very cautious if you hear a provider or facility say, “We will write off your deductible.” This is ILLEGAL. May sound great, but insurance companies could go after you as the client with penalty’s and lawsuits. Please report if you here this at any facility.
  • Co-Pays
    • If seeking treatment through an outpatient provider or facility, you most likely have a co-pay. Co-pay can range form $10 to $50 depending on the provider. (note: deductible needs to be met in order for you to pay co-pay rates.)
  • Check your Explanations of Benefits (EOB) on a regular basis while receiving treatment.
    • An EOB is what your insurance company will send to you and also the provider or facility.  This will show what services were billed, what insurance paid, and what you as insured are to pay.
    • This is your first line of defense when you have questions about a bill.

3. In-Network, Out-of-Network. What is the difference?

If using your insurance to receive care, that insurance company will have a list of providers and facilities that are fully credentialed and contracted with them (In-Network). Any other provider or facility outside those requirements are considered Out-of-Network.

It matters to know this because going to an ‘In-Network’ provider or facility is much more affordable to you. Most insurance plans have what is called an 80/20 plan. Meaning that after deductible is met, the insurance will cover 80% of costs and you as the insured are responsible for 20% of the cost.

‘Out-of-Network’ providers are more expensive. Always check with your insurance to see if you have these benefits. If you do, your coverage can range from 60/40 (60% insurance pays, 40% you pay), 50/50, 40/60, 20/80 etc.

The upside to staying In-Network. One, obviously more affordable. Two, you know the provider and/or facility are licensed. Three, very good chance of services to be covered.

The downside. You are limited to who you get to see. Meaning, if you do not have Out-of-Network benefits you have to stay In-Network.

The upside going Out-of-Network. You have a more free range of where to go for treatment.

The downside. One, more expensive. Two, less chance of services to be covered. Three, potentially drain your benefits. Out-of-Network provider and/or facilities can charge the insurance as much as they want.

For example, if you attended an IOP with an In-Network provider, they have a set rate with the insurance company (ex. $180/day). Out-of-Network can have the same services, yet charge insurance much more ($900/day). This can really drain all your benefits at a surprisingly fast rate and you could be slapped with the remaining bill that insurance did not cover.

What I suggest, try your best to stay In-Network.

Note: A lot of inpatient facilities are Out-of-Network. Do not be discouraged, just be sure to do good research on facility.

In my humble opinion, if an IOP is Out-of-Network it is probably for good reason, and it is not a positive one.

4. You Can Buy Treatment, You Can Not Buy Recovery.

Do not be mistaken. Treatment is the best way forward to finding long-term recovery, but it is not a fix all. A good treatment provider will give the client new and healthy coping mechanisms throughout treatment. Working on a discharge plan the first day of treatment is crucial. What the client does outside of treatment is the biggest challenge.

Make sure the treatment provider has very good resources for support outside of what they offer. Be cautious of a place that claims to have everything you will need for recovery. Just as 12-Step programs do not have a monopoly on recovery, neither does one treatment center.

A/D believes that even failed stays of treatment in any setting (inpatient or outpatient) is beneficial for someone. It is never what you say about your treatment it is what you DO!

I am extremely blessed to work in the field of recovery. Seeing the lights turn back on in someone is why A/D continues to do what we do. Putting the client first before anything. We are not in the “hijacking” of clients business. Our goal that has never changed is finding the right care for the person at an affordable cost.

Thank you for letting A/D continue to serve your community.

 

Dylan Dusoe

Administrator

Posted in Administrative, Family and Substance Use Disorders, News, Uncategorized | Leave a comment

Getting Them From Medical Detox to Rehab Not An Easy Transition

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http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(14)00234-7/abstract?rss=yes

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FDA Encourages Development Of Abuse Resistant Opioid Medications

FDA takes important step to increase the development of, and access to, abuse-deterrent opioids

 

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm492237.htm

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