Finding the help you need to deal with a substance abuse issue is most likely going to be one of the most difficult and challenging decisions that you will have to make. Whether it is you yourself dealing with the problem or you’re trying to help a deserving family member, making the decision to put someone into treatment and get the help they need can be a tough one.
Choosing the right treatment option will need to begin with your insurance coverage. For those who have First Choice Health Insurance there are a few steps and guidelines that you will have to follow to ensure that you get the right coverage for the services needed.
Who They Are
First Choice Health Insurance specializes and works together with several different state agencies in order to provide you with the best selection of health options for your particular needs. Because they work directly with state agencies they will have negotiated with several health care providers for a preferred rate for the services that they provide. This way you can get the lowest possible price for your treatment services than if you were to set out to find a center on your own.
Choose Your Primary Care Provider (PCP)
Chances are that if you have not already done so you will need to choose your primary care provider to take care of your general health issues. This provider will become your mediator between you and the insurance company and you and the treatment center that you will use.
One of the first things you will want to analyze is the list of providers that you will choose for your treatment options. While First Choice may be willing to pay for out of network providers you will save on your out of pocket expenses if you choose the in network providers for your services. First Choice will provide you with a list of approved providers to give you a variety of choices.
Depending on the type of plan you have you may be expected to get a referral from your PCP before you can sign up for any substance abuse treatments. To determine if you need to get a referral first, you must check your schedule in your Benefits Plan Handbook. This should tell you whether your substance abuse program requires an approval or not. If the rehab services you’re looking for is not covered under your plan then you must make this choice before you can start any type of treatment. Even if you know you’re in need of a specialist it is important that you go to your PCP first; from there, you will be referred to a specialist to see that your health issues will be met.
If for some reason you opt for a PCP that is out of the network or if the program you need is not listed you will be walking into your treatment blind. They will not be able to tell you just what portion of your bill you will be held responsible for. You may be only liable for a small percentage of the bill or the entire 100%. This is why it is probably best that you select from their list of preferred providers.
The Importance of the Referral
It is very important that you make sure that you get your PCP’s referral before you proceed to get any type of substance abuse treatment. There are several reasons for this. First, without that prior approval First Choice may not be willing to sign off on your treatment. If that happens you will be expected to pay the entire bill for your services. Even though mental health is covered under the First Choice policy without prior approval from you PCP they have the right to refuse to pay.
The second reason is simply because all addictions are not the same and therefore require different approaches to help a patient. When you work together with your PCP you will be directed to the type of program that best suits your particular needs.
Getting the help you need to deal with drug and alcohol addiction can be a very trying time for all. While they may be happy that the individual is getting the help that is needed it is still a difficult process for everyone concerned. You’re making the right step by moving ahead with the treatment option but seriously consider how you can make the whole process better by choosing the right PCP.