The road to get someone into treatment is always difficult. Usually, the family has put an enormous amount of energy into just getting their loved one to the front door of the facility. But what comes after someone checks in?
Many families want or need to use their insurance to cover inpatient treatment. If you choose to use your insurance, your treatment duration will be controlled by the insurance company.
Out-of-Network: If you choose an out-of-network treatment center, the facility should be able to determine what your insurance will cover. You’ll have to pay for some of the costs of treatment—namely, the deductible and the co-insurance percentage.
In-Network: If money is tight, many people choose to go to an in-network facility. There is an important thing to keep in mind if you go that route, though, and that’s the fact that your insurance company may make staying in the facility for a long period of time difficult. Though logic and common sense may say that the patient needs significant time to cover, insurance companies don’t always see it that way.
At an in-network facility, insurance only covers blocks of days. Typically, insurance covers detox without any questions—a period of eight days. After that initial block of time, the facility will request more time, which insurance companies can authorize (or not) in declining blocks of days (eight days, four days, three days).
This can be a difficult thing for families to grasp. They know their loved one needs help, they know that he or she checked in for 28 days, and then insurance companies will only pay for a limited period of time. Whenever possible, the family should maximize what insurance will pay for, and in some cases insurance companies will cover the full 28 days.
However, if that doesn’t happen, and insurance cuts you off, it can be a very difficult situation. The remainder of your loved one’s treatment will not be covered, though he or she more than likely hasn’t had enough time to recover. In such cases, the facility will offer a cash rate for the remainder of treatment. It may feel, to you, that the facility lied or is being greedy—but, unfortunately, the treatment center doesn’t know how long your insurance coverage will last, either, until your loved one is already in the program. If insurance cuts your loved one’s treatment short, plans must be made for them to continue treatment in an outpatient setting.
Checking into treatment can be a tedious process. It usually involves an in-depth medical history, a review of your insurance and associated costs, and possibly preparation for detox. One concern shared by many people who check into treatment involves who has access to their medical information, and that’s determined by a series of releases the patient can choose to sign or not sign. An adult who checks into treatment is fully in control of their own medical records.
Without a release signed by the patient, the facility won’t give any information to loved ones or anyone else who asks for it. This can be upsetting to family members, but it’s important to understand that the patient is in control of their releases. There are a few different levels of releases that can be signed. For instance, a patient may allow loved ones to call and verify that they are still present at the facility, and to leave messages for them. In this case, the treatment center will generally call with weekly updates. Higher levels of release can include full medical records and discussions with providers.
No matter what, the details of a patient’s conversations during therapy are kept private. Even if higher level releases are signed, the family’s discussions with providers are usually pretty general: how the patient is doing, any problems they may be having, and plans for aftercare.
Take a Few Days Off!
Getting someone into treatment is a deeply stressful, taxing process, and the days before a loved one steps through the front door are always very emotional. After the person struggling with substance use enters treatment, I always tell families to take a few days off. For the first time in a long time they don’t need to worry about their loved one, and they can focus, instead, on shifting their mindset to loving support. In the first week, your family member maybe pretty sick and very medicated, while they go through detox.
Depending on the quantity and type of drugs and alcohol that were consumed in the days and weeks prior to treatment, expect that you loved one will be in “detox”, a higher level of care, like a mini-hospital for a few days to a week. The first few days, maybe heavily medicated – your loved one will probably be spending a lot of time sleeping and in no mood or shape to make phone calls out. Detox can be a pretty quite time.
No News is Good News
When a loved one is in a treatment program, families often become worried—they want to know how things are going on the inside! Most families become somewhat disappointed with the communication from the treatment center, as most employ a no-news-is-good-news policy. Don’t get too concerned: the team at the treatment center are experts, and they know what they’re doing. You can expect a few calls every week updating you on your loved one’s progress—as long as they’ve signed the consent form, that is—but you shouldn’t expect a daily call.
Your loved one may be allowed to call in the evening and on weekends. Keep those calls light, if you can; now is not the right time to try to bring them to account for the damage they’ve done.
At some point in early treatment, it is common to receive a phone call that is basically communicating “this place sucks, come get me”. The call can be guised in several different ways, the food, my roommate, the therapist; there is always a complaint.
It is important to acknowledge the complaint, but don’t jump into the hole with your loved one. In the early days of recovery, they will go through many mood changes, and cycle through them quickly. Take the complaint, and do not take action, it would be ok to call their therapists and express the concern and the facility can address the situation.
A good facility will have a program that includes the family, this may include a day or weekend on campus, or several video calls. These are important calls as after-care will be discussed and reintegration into the ‘real world’.
The family program is a good time to work out feelings and to address the relationship between the addiction and the family. A lot of damage may have happened,; the family is hurt. These joint sessions are the perfect time to work on these feelings as there is support for the person in treatment and for the family.
After treatment the dynamic of the family will change for the better, and it can be a rapid change that is unsettling. Like it or not, the family was used to living with the addiction and was possibly supporting it. Working through feelings and making plans for the future can begin in the safe space provided by the facility.
The main staff at a facility is off for the weekends. Often weekends feel a bit lonely and are a let down from the busy weeks and emotions of the reality of the situation hit hard. You will likely here from your loved one on the weekends. Just understand that the time is slow for them on the weekend. They may need some extra loving support on these weekend calls.
Setting up Aftercare
Just about as soon as treatment begins, the family—with the support of the treatment team—will need to put plans in place for their loved one’s continued care when inpatient treatment ends. Not doing anything differently after treatment is almost certain to lead to relapse.
The facility will speak to the recovering person about options. For most people 28 days is not even close to enough treatment, and so the facility will likely recommend a longer stay or an extended care stay. These recommendations offer the highest levels of care, and are typically the most expensive options.
It’s important that the family weigh their choices carefully, determining the most feasible option by considering, among other things, costs and the person’s previous commitments.
After treatment is completed, the recovering person will be discharged from the facility. Your loved one should be carefully monitored for their first few days outside the treatment facility as they reintegrate into the family and into their “normal life.” As a first step, someone should meet them at the facility and travel home with them. Leaving treatment can be very disorienting; for your loved one, the facility has become a safe and friendly place, and returning to the outside world can be a jarring experience. It’s not yet the time for them to take a long trip alone.
At this point, plans should already be in place for aftercare. At the treatment center, your loved one adhered to a strict schedule and had a lot of support; back in the real world, they should jump into aftercare immediately.
Adam Banks is a certified recovery coach and interventionist at Suntra Modern Recovery. He received an MBA from the University of Chicago and built a company which United Health Care acquired. He learned his rigor and attention to detail from his career as an airline pilot, holding an ATP, the FAA’s highest license.
Suntra Modern Recovery provides medical treatment for alcohol and opiate addictions via video visit with medical doctors. Suntra’s alcohol and drug intervention services are available in New York, Long Island, and the Hamptons. Treatment for opiate and heroin addiction, including Suboxone treatment, can start today.