So You Need Mental Health or Drug Rehab?
Navigating the process of finding treatment for yourself or a loved one.
Posted Jan 29, 2018
So you need a drug or mental health rehab.
A million thoughts are running through your head, not the least of which are: “Why me?" “How?” and “How much?” There are undoubtedly lives at stake, and for many, this is a completely new terrain.
So you do the usual: Call friends and family, ask around, get a few referrals, but mainly you “Google,” crawling through thousands of links with thousands of options and tens of thousands of opinions. And time doesn’t seem to slow down enough. Life is moving all around you, and you feel like you are standing still, and responsibilities are still responsibilities.
If only there was a clear and concise manual to navigate this process? Let's give it a shot.
In order to choose the most effective treatment, it is vital to have a clear picture of the problem and the stages of addressing them.
The problem is not an easy thing to summarize, and it is comprised of a million components, not all of which are entirely clear at the moment.
Here are a few things that you should do to get a clear picture. Some of these will come in handy later on (see “building a case”).
It is vital to be able to separate what is a historical issue—“He always had trouble in school”; “I think there was some trauma in summer camp as a kid”; “It took her a while to walk”—from the issues you are facing now.
All of the data is important, so don’t rule it out, but when trying to get a clear picture of what the problem is right now and convey that to treatment providers in the hopes of picking the right one, you need to be able to give the “highlight reel."
The last thing you want to do is spend an hour giving the entire history of your loved one to a random admissions person only to be referred elsewhere to repeat it. Many people get burned out by this and end up making poor choices as a result. Historical data will come into play later (see “building a case”).
The issues a person is facing should read like a movie summary, cover letter, or resume. They should include:
- Recent Events (arrests, overdose, runaway, hospitalization, panic attack, extremely stressful or traumatic events)
- Recent Feelings (low self-worth, loss, depression, anger, lethargy, anxiety, stress, suicidal ideation)
- Recent Behaviors (withdrawing, running away, ticks, hallucinations, bed wetting, self-harm, aggression, outbursts, drug use, drug selling, manic behavior)
- Recent Care (therapist, doctor, meds, level of care engaged in, success or failures in care, recommendations of current provider)
- Red Flags (poor eating or sleeping habits, hours unaccounted for, school/grade/work issues, elevated or depressed mood, social withdrawal, avoidance). Just remember that red flags can be very subjective and relative, and let's face it: You aren't a therapist. And if you are? You aren't your child's therapist. So focus on the other more concrete items first.
When looking at treatment, it is critical that one realizes that:
1. Treatment is a process.
2. Mental health and addiction issues tend to be a lifelong struggle.
3. No one center will ultimately be “responsible” for the “fix.”
4. There is no "fix."
For this reason, we refer to the “Continuum of Care” as the method by which treatment is implemented, being the stages of addressing “The Problem.”
Let's look at the process:
1. Problem/crisis/here and now
2. Getting to/engaging in the immediate and most applicable level of care/intervention
3. Consistent engagement in the treatment and decrease of symptoms
4. A decrease in the level of care
5. Return to pre-treatment management levels with an aftercare plan that addresses the issues that led to a higher level of care in the first place.
6. A long-term plan for stability
As you look at that, you can see that any one intervention or stage is not going to be the final one, and often any one of them can take a long time or repeat itself.
For this reason, as cynical and cold as it may feel, you need to budget accordingly and develop a “treatment bank account” in your mind.
Anyone would do anything for a loved one, but you are no help to anyone if you run out of assets while only part of the way through any one of the above-mentioned stages.
Therefore, the trifecta you need to be evaluating is:
Quality vs. Quantity vs. Cost
Quality: You may be able to get a “more intensive” 30-day rehab program with the best reviews, most decorated doctors, and most beautiful location, but will that 30 days eat up your entire budget? And what happens after 30 days?
Quantity: They may have multiple levels of care, including after-care, but how intensive is the care? Can you afford the care?
Cost: They may be incredibly cost-effective, but do they have multiple levels of care? And how intensive is the care? What is the quality of the program?
So how do you evaluate these items?
I will start with cost, as this is often the most pertinent factor and is definitely the easiest to determine. Using this, you can more easily categorize the other items
Private Pay Cost: This is as it sounds: What is the cash rate to receive treatment? Do they have a scholarship (many do)? Do they offer payment plans or even lines of credit? Do they work with such things as EAP: Employee Assistance Programs, or IEP: Individualized Education Programs? Many times for the specialty programs, there is an independent approval process that you must engage in with the support of a specialist not associated with the treatment center.
Insurance: Unless you have unlimited resources, and even if you do, the first thing you should be doing is looking at whether or not a program takes insurance. Whether or not you are ultimately going to make a decision based off of cost, knowing the insurance piece is critical because:
1. There are many incredible programs that take insurance.
2. Knowing the insurance piece will help you visualize your “treatment account,” budget for the long term, and even offset the “Quantity” part of the equation by enabling you to extend the 30 days to, say, 45 days because 15 are paid for by insurance.
3. If they take insurance, and you intend to use insurance, you need to build a case from the outset.
With insurance, you also want to know:
1. Are they “In-Network” with your insurance or “Out-of-Network.”
If the facility is “In-Network” with your insurer, it means that they have a negotiated rate (less guesswork for you and them) as to your out-of-pocket expenses, and they will tend to get paid faster (less need for a deposit). It also means the overall cost and out-of-pocket max/deductible will be lower as an incentive by your insurer to remain "In-Network."
Conversely, It also means that the center may be more “ingratiated” to the insurer and will potentially be less likely or able to fight for longer-term care once the client is denied.
Additionally, as most “in-network” rates pay providers significantly less than “out-of-network” rates, there is also the stigma of “in-network” care being “lower quality” than “out-of-network” (though this is changing as providers learn to adapt while still competing).
2. Do they do “Standard” billing or “Superbilling”?
Facilities that do “standard” billing need to ensure that each day is authorized, and they clear each bill by the insurer and get paid directly by the insurer. This means that they ensure that they are offering approved care, at approved standards, and with the appropriate certifications and with appropriate documentation; otherwise, they stand to lose money.
Facilities that “Superbill” take your deposit in advance, often do not get authorization from insurers in advance, are not necessarily ensuring that all services rendered are necessary, approved, or provided within the requirements of the insurer (such as ensuring the use of licensed therapists, accreditation, and certifications, etc.).
Upon Discharge, Facilities that “superbill” simply provide their clients with a summary of care and associated billing codes in the form of a “superbill,” which the client then needs to use to pursue the insurer on their own to get paid.
3. Is the treatment center “accredited”?
Simply put, “accreditation” means that in addition to whatever licenses are required in a particular state, the treatment center adheres to a gold standard, and has been inspected and “accredited” by an independent organization, such as CARF or JCAHO.
Most insurers have specific clauses that require providers to have this, and while many providers do not and still get paid, there is always the chance that the insurer will subsequently deny care mid-way through treatment and/or even request their money back post-care.
Regarding Insurance: If you don’t have insurance, it is not hard to get, and finding a competent broker with experience can go a long way.
Here are some key items you want:
- Preferably a PPO (Out of Network) plan, as this gives you access to both “in-network” and “out-of-network" options
- A plan that has a CAP on out of pocket expenses (out of pocket MAX) and deductibles such that after a certain amount (usually $5-10k per year), the insurer pays the rest
- A plan that allows for all levels of Mental Health and Addiction care: Hospital, Residential (RTC), Partial Hospitalization (PHP), Intensive Outpatient (IOP), and Outpatient (OP) care
- A plan that does not have any “Day Caps,” or limits on how many paying days of care it authorizes so long as it's clinically/medically necessary
- A plan that does not have any "Pay Caps" or specific limits on what they pay per day. Alternatively, if they do, then make sure they are reasonable and competitive rates, and you get it in writing as many insurers intentionally do not reveal what they will pay per day.
Quality is a harder thing to quantify (see what I did there?). It is also tricky to get good opinions on centers just by reading reviews because these centers deal with folks who tend to be facing monumental challenges, and often lack insight into their own issues, thus leaving much potential for one-sided, very emotional, and searing reviews.
It is hard to find a single center that doesn’t have a series of negative reviews, even when that program is the best clinically.
When it comes to other providers and their opinions, it is equally hard because of the unspoken competition and referral networks that each depends on to survive.
The best way to get a clear picture of a treatment center is by doing the following, if possible:
1. Visit the location and talk to people.
2. Obtain references from the center for both past clients as well as referents.
3. Obtain reviews from hospitals (over other providers), community leaders, and accreditation organizations.
4. Keep an open mind, look at the website, and read reviews with an eye toward consistent issues.
5. Have your loved one do the same, so they are invested in the process, and so you can see if they connect with the center and the admissions staff on an emotional level.
As treatment is a process, and it won't end in any one level of care, it is important that no matter which center you choose, you have an eye toward long-term care. This means that:
1. The center itself has multiple levels of care and can work on a plan to step the client up/down as needed while maintaining consistent care
2. The center has a tight network that enables them to transition the client seamlessly (including working with the insurance when indicated) to the next level of care and be available if the client needs to return.
3. If using insurance, the center does so with an eye toward after-care and doesn’t plan on keeping your loved one as long as possible while using up authorization for multiple levels of care.
Other factors that contribute to quantity include:
1. The centers having experience with insurance and a reputation for being able to authorize and fight for a good amount of care
2. The center is willing to work with you and take whatever the insurer gives them without pursuing you for the balance (outside your legally obligated out-of-pocket requirements from the insurer). Many centers utilize a "Balance Billing" process, which, while not illegal, can be challenging as they pursue the client for the difference between what the insurer paid and what they billed the insurer. This can amount to thousands of dollars and is often unpredictable at the outset with "out-of-network" facilities.
3. The center has a scholarship, grant, or loan program.
Making the right choice is never easy, and the synopsis above does not begin to take into account the emotional roller coaster you are surely experiencing, as well as the myriad variables that play off of each section.
Ultimately finding an advocate for yourself and your loved one will be the difference-maker, and this can be in the form of others who have gone through the same experience, parent support organizations, addiction, and mental health professionals, educational consultants, etc. Often it can be an incredible and helpful soul working admissions at one of the many centers you call. I try and hire those as often as possible, because this journey is a long one, and the road is best traveled with the support and experience of a dedicated helping professional.