Handling serious medical, emotional, or behavioral problems can be a very difficult and challenging undertaking. The idea of getting needed help for someone can take its toll on the average person and when it comes to finding treatment centers for behavioral problems like substance abuse it can be even more complicated. Because of this it is essential that you understand exactly what your options are, what you can expect, and what responsibilities the providers will expect from you.
CareSource is a nonprofit managed health-care plan that makes up a major part of Medicaid in some states. Depending on the state you live in you will have a number of options for your medical rehabilitation. While all Medicaid insurance plans provide some level of substance abuse coverage it is important that you know exactly what type of coverage your plan allows for.
Find A Doctor
Before you can begin any type of substance abuse treatment through CareSource you will have to choose a doctor. Every member of CareSource is required to make this choice. Your primary care physician will be your portal to your treatment options, they will be the ones that will manage all of your health care needs. If this is your first time with CareSource you’ll need to make a preliminary appointment so your PCP will be better able to assess your immediate needs and their urgency.
In the case of substance abuse or other similar issues you may be allowed to choose a provider outside of the CareSource listed directory. However, it will be necessary for you to consult with the CareSource office prior to making such a commitment to make sure that the provider is approved. If you fail to do this prior to meeting with the outside provider CareSource has the right to refuse to pay for such services and you may be left to foot the bill out of your own pocket.
The Referral Process
When it comes to substance abuse or other behavioral issues you may self-refer directly to the state Mental Health and Addiction Services or a state certified mental health center for treatment. To find out if a treatment center has been approved by the state you will need to see the CareSource Provider Directory, call the Member Services Department, or visit the CareSource.com website.
According to the CareSource plan, a patient is allowed up to 30 visits each year without a referral from their PCP. If you have chosen a psychiatrist that is either working privately or in a center that is not on the PCP list you will need to get a referral in before you begin treatment.
For Inpatient Hospital Care
If you have been admitted to a hospital for your drug use then you will not need to get prior approval for any treatment that you receive. Emergency room services do not require a referral or prior authorizations. However, if you need to see a specialist for your treatment or you will not be released after your emergency room treatment then you need to get in touch with your PCP as soon as possible to get the needed referrals.
Depending on the type of treatment you may be given certain medications to control your habit. While CareSource covers all medically necessary medications, they prefer that your prescriptions be on the preferred drug list (PDL). Your primary care physician will be expected to submit information to CareSource prior to authorization, to explain why the medication is needed. Once the request is approved you will be able to receive your medication.
There are also times when a drug may be approved for only a limited amount of time and once you’ve reached that maximum amount or time limit, CareSource will cut off all coverage for that medication.
Controlled Substance Management
Another way that CareSource can help with your rehabilitation efforts is through Care Management and Outreach Services. Through this program, their registered nurses, social workers and other outreach workers can work with you one-on-one to help you with your unique needs. To get this added assistance, your doctor may request for you to have a visit because he feels it will benefit you in some way.
This resource can be useful to many when used in the right way. They can consult with your PCP and other service providers to coordinate all of your care to meet your immediate needs (this can be very beneficial if you’re found to have other medical conditions that are in conjunction with your substance abuse habits.
This type of controlled management must receive prior approval. While CareSource will not pay off inpatient treatment to stop using drugs and/or alcohol, inpatient detoxification services in a general hospital care is covered.
Substance abuse is already a difficult and challenging problem to overcome. The effects of this kind of addiction can also be a precipitating factor that could lead to even more problems with your health and social lifestyle that could place you into an endless cycle that can be quite overwhelming. Add to that the problems that come from having financial difficulties and dealing with a substance abuse issue can be more than the average person can deal with.
With government-sponsored health programs that will ensure you the treatment you need, much of these problems can be resolved. CareSource is a useful tool that makes freeing yourself from such problems possible. However, it is essential that you follow all of the guidelines set out in their member handbook before you proceed. It is your responsibility as a CareSource member to familiarize yourself with all of the details relating to your plan before you make any medical decisions. The more you understand about the policies set forth by Medicaid and CareSource, the better your chance for success and freeing yourself from the addictive habits that may have taken over your life. If for any reason you’re not sure of the proper steps you’ll need to take to get your substance abuse rehabilitation treatment make sure that you either call the CareSource information hotline or visit their website for the assistance you need.