Is It Mental Health or Addiction?

associations. Inquire whether they are active in professional associations. Determine how they assess whether someone is ready for a specific therapy or service. EMDR is not recommended for some cases of complex trauma.  It is important to ensure that the person working with you has access to good clinical supervision.It is also important that the treatment is paced in such a way that you do not become re-traumatized.  Trauma work takes time.  There are no quick fixes.

Treatment facilities usually have to report to your insurance every 2-3 days or at set intervals determined by the insurance company when they want to be updated about your treatment in order to determine whether you meet their “medical necessity criteria” for the “level of care” the facility is requesting “authorization” or “pre-certification” for. Detox is the highest level of care, followed by inpatient or residential, followed by partial hospital that sometimes has housing connected to it. Insurance companies want to see that your treatment is progressing; the goals are realistic and that you need to be there. If a place is licensed to treat both mental health and substance abuse it is not uncommon to see them bill under mental health once benefits have been exhausted under substance abuse. Some policies only authorize 30 calendar days per year. Others authorize an unlimited number of days. It is again all based upon medical necessity. Check with the facility to determine whether you are responsible for “room/board” charges if the level of care gets dropped to “partial hospital” also known as “day programming”. Some ask the patient to pay the difference between what is billed and paid. When a facility is “in-network” with your insurance generally they are agreeing to accept whatever rate is negotiated between the insurance company and their business office staff. 

Be careful of or concerned when a center inquires within minutes for your insurance information. There are many treatment centers that out-source calls to third-party marketers that do not necessarily work for the treatment center directly. They are independent contractors whose goal is to ensure the beds are filled in that facility. The focus with these entities is not so much on whether you are going to get the right of help as much as meeting his/her commission or quota needs. 

You should also be careful of treatment centers that allude to your problem being resolved in 30-days.  Research is showing that the longer a person stays in treatment (not necessarily residential) but is some form of structured, supportive, monitored, phased type of treatment that their chances of achieving long-term success in recovery improves greatly. Do not be pressured into going to the specific provider the individual recommends. Many recommend only places they are affiliated with. If they are connected to a place financially and are profiting from your referral to a specific place this would be concerning.

In closing, do your homework, ask questions —–speak directly with clinical staff regarding clinically related questions. Do not commit to long-term stays, large down-payments (,000-10,000) and have them give you a bill to submit to your insurance because your treatment needs to be authorized “in advance” not after services are rendered. When it feels like the person your speaking to is more of a sales person chances are that’s all they are rather than someone who has an interest in ensuring your needs will be met. Do your research and if feels right then go with what feels right. If not ask questions. Remember, it’s your treatment, your recovery, your life, your happiness and you need to know your making the right choice in whatever you choose.

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