Calling Your Insurance Company

We bless them and we curse them. We try to understand their rules. We get caught in loopholes. Claims are delayed or disallowed for the most ridiculous reasons. We get just as frustrated as you do. At Resolutions we spend thousands of dollars every year so that we can bill them, comply with their rules, allow their audits, see their members, and provide you with the services that you want. Every month we bill dozens of insurance companies. Most are reputable and very helpful; some are not. Some plans are excellent; most are mediocre at best. Some are downright outrageous. I’m sorry if you’re in that group.

Being an educated consumer can save you lots of money!

Of course, you don't have to use your insurance. We're glad to accept credit or debit cards or cash for a discounted rate.  For those with a high deductible paying the cash discount could be a way to keep therapy affordable without the hassle. But, if you want to use your insurance, it pays to educate yourself. We bill dozens and dozens of different plans every year and are happy to do so as a courtesy to you. Please understand, however, that we offer no guarantee that your insurance company will pay. That is between you and your insurance company.

We are happy to bill for you.  We know a lot about insurance companies in general. We may not know about yours. There are just too many out there. In addition to that , plans change, rules change, and we're not informed of those changes--you are. We expect that you do your part by being an educated consumer, asking questions if you don’t understand, and communicating with your insurance company should a problem arise.  Many, many clients have saved themselves hundreds of dollars by understanding their insurance plans and taking the trouble to authorize their mental health visits ahead of time.

How to educate yourself

Navigating through the health insurance industry is a challenge. It is even more of a challenge if you do not understand the language that is used by those in the industry. So, to help you out, we are happy to tell you how to ask about your mental health benefits. We really do want you to be an educated consumer. Here’s what to do:

Look at your insurance card.

The “member ID” is on the front. Have the card in hand when you call your insurance company.

Turn your card over.

On the back you’ll see various numbers. Perhaps you’ll see an 800 number for customer service. More specifically, if your insurance company lists an 800 number for “behavioral health” or “outpatient mental health services,” that’s the number you’ll want to call.

When you call the number, you’ll reach a representative who will ask you what you want.

Ask ALL of these questions.

“I’m calling to determine eligibility and benefits for outpatient mental health therapy with Kathie Keeler, licensed clinical social worker.” They will ask you for your name, your member ID (or social security number), and date of birth. After they have determined that you are who you say you are, be sure to ask the following:

• Do I need a pre-authorization number prior to seeing someone?

• Do I need to keep track of the number of visits? (Usually you do.)

• Do I have a copay? How much is it?

• Do I have co-insurance? (This is a cost-sharing arrangement between you and your insurance company in which you pay a percentage of each visit.) What is the percentage? This is usually true for some Blue Cross/Blue Shield plans, which have both a copay and co-insurance. (It gets tricky because you have to pay both a percentage of each visit as well as a copay each time.)

• Do I have a mental health deductible? If so, has it been met this year? Some companies have a separate mental health deductible. So, even if you've met your medical deductible, it doesn't necessarily mean that you've met your mental health deductible. If it hasn’t been met, you’ll want to find out what you will need to pay at the time of the visit. You can do this by asking the following.

• What is the contracted reimbursement rate on my plan for an initial visit, billed under the CPT code 90801?

• What is the contracted reimbursement rate on my plan for subsequent visits, billed under the CPT code 90806?

More information you may need to know:

• If your insurance company only gives you five visits, you have the obligation to count your visits so that you don't go over your allotted amount. This is your job; not ours.

• Some companies will want to know the date and time of your visit prior to giving you a pre-authorization number. They ask this to determine whether or not the therapist has availability. Give them a date and time.

• Some insurance companies will want to know why you want to see a therapist. They ask this to determine whether or not the problem is “medically necessary." Most insurance companies will only cover medically necessary diagnoses, such as depression or anxiety. You have the right to privacy. You don’t need to tell your story to an insurance company representative, and probably shouldn’t.

• Be aware that insurance companies can only stay in business by making a profit. They do this by saving money. And this is where the horror stories begin. What you say can used against you.
  

  What NOT to say:

1. “I’m court-ordered to therapy."
2. “I want marriage counseling.”
3. “My child has AD/HD.”
4. “I’m just stressed and want to talk to someone.”
5. “I need some anger management classes.”

Although all of these things may be true and legitimate, your insurance company could use this information to disallow visits. Please talk to me first.

You will be given a diagnosis.

Please be aware that your insurance company cannot be billed without a legitimate "medically necessary" diagnosis. This diagnosis is part of your permanent record--not only with the insurance company, but also with the Medical Information Bureau (MIB) The MIB is a central database of medical information shared by insurance companies. About 600 insurance firms use the services of the MIB primarily to obtain information about life insurance and individual health insurance policy applicants. When you apply for life or health insurance, your insurance company may look for codes in the MIB that indicate you've had a problem in the past. The MIB is not subject to HIPAA. So, even though our records are confidential; your insurance company will likely forward the diagnostic codes to the MIB. Not only can insurance companies deny applicants based on prior treatment, certain government positions may require an explanation of why you were treated for a medically necessary diagnosis--even many years previously.

Preventing Relapse

Drug addiction is a complex but treatable brain disease. It is characterized by compulsive drug craving, seeking, and use that persists even in the face of severe adverse consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar to those for other well-characterized, chronic medical illnesses such as diabetes, hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses and diminish their intensity, until abstinence is achieved. Through treatment tailored to individual needs, people with drug addiction can recover and lead productive lives.

The addict has a chronic, pervasive, progressive disease. In early recovery he/she CANNOT behave in the same way that other members of society do. In other words, the addict must identify and avoid those triggers that would lead to relapse. Although different people respond to different approaches, the research is clear on which approaches have the best success rates. The standard recommendations include:

1.    Recovery must be the number one priority in the recovering addict’s life.

2.    90 meetings in 90 days. The addict must substitute recovery for drug use and drug-seeking. Once addicted, the mere anticipation of getting high will trigger a marked dopamine response in the addict and/or alcoholic. Likewise early recovery from addictions is often hampered by the lack of dopamine d2 receptors that take many months to return to baseline functioning. The lack of sufficient d2 receptors is a primary reason that many drug addicts and alcoholics fail at abstinence during the first 90 days of their recovery.

Following the first three months of sobriety, the addict should attend no fewer than 3 meetings per week. After the first two years, the recovering addict can reduce this amount to one meeting per week if everything else is going well.

3.    Sponsorship. Daily calls and weekly meetings with a caring recovering addict are vital. Checking in with a caring person improves accountability.

4.    Step work. Homework assignments must be done and given to the sponsor on a weekly basis.

5.    Total and complete abstinence from ALL mind-altering drugs. This includes alcohol, even though it’s legal.

6.    A detailed and careful history to determine which triggers lead to relapse.

7.    Change of “playground, playmates and playthings.” The addict must avoid using friends, as well as places and activities that re-activate cravings.

8.    Abstinence from other addictions—cigarettes, pornography, etc.

9.    Relationships must be put on hold until the addict is on a firm footing with his or her sobriety. Although friendships are important, new relationships with the opposite sex should be avoided during the first two years of recovery.

10.    Study of inspirational literature. The people who have the greatest success rates are those who find a Higher Power and are able to “let go and let God.”

As I mentioned earlier, different people respond to different approaches. The above list has been standard for many years with minor variations for different people. With further research, even more variations are possible.  Those of us in the recovery field always hope for more research that can help the addict that still suffers.

Stress Relief

I was looking at my list of things to do yesterday wondering how I was going to get everything done. Sometimes I do more than what I can reasonably handle. And I know I'm not alone in feeling the stresses and pressures of daily life. Every day in counseling I see people who are stressed, anxious, nervous, pressured, and burned out. Life can certainly be stressful for all of us.

Slow down and relax for a moment.

We are all seeking solutions to problems in life.  But it's important to take the time to recognize stress and the body’s need to relax, even if the pace in your life is not slowing down. Guided meditations and breathing techniques can help give you simple ways to relax, even if for just a few quick minutes in the middle of a busy day.

Count your breaths.

The easiest way to start off when practicing guided relaxation is to count your breaths as you inhale and exhale. You don't need to do a lot. Start with five.  After all, our lives are busy.  Breathwork that involves inhaling through your nose as deeply as you can, will help your body start to relax. Hold this breath and then let it out slowly through your nose. Your heart rate will start to slow down and your muscles will start to relax. When learning relaxation meditation, remember to have a focus for the meditation, such as on your breathing.

Recognize and dismiss thoughts.

During relaxation meditation, all kinds of thoughts will come to mind. As you learn to recognize these thoughts and then dismiss them, your meditation will go deeper.  This is one of the main reasons why you will want to choose a quiet place for meditation where you will not be interrupted by the normal sounds of your life when you are teaching yourself how to to do this. Meditation for beginners can be frustrating when you can’t seem to get it right the first time. Just hang in there.

Stay focused on your breathing.

The key is to stay focused on meditating and to focus on your breathing techniques. The thoughts of frustration are ones that can take over and ruin relaxation methods for you. One great practice in meditation for beginners learning how to relax is to concentrate on the parts of the body. Start with your toes and focus on them as you feel them relax. Then move upward concentrating for a few minutes on each body part and how it relaxes. As you get to your head, your body will be completely relaxed. Ahhhhhh. It feels so good.

If meditation is not for you, don't worry.

The reason I like using The Wild Divine, a biofeedback tool designed to aid in the learning of relaxation and meditation, is because it's easy to sit at the computer and watch "a video game." (It's really not a video game, but it looks like one.) I find The Wild Divine works well with beginners, children, and people who suffer from anxiety. So, if the breathing and meditation techniques aren't helpful for you, use The Wild Divine instead. Biofeedback is a simple, but powerful tool that helps you to communicate with your body. You'll wear finger cuffs which measure your skin temperature and allows you to move through levels of the games. You can watch the demo below and see what I mean. Be well.

The High Costs of Drug Abuse

So often I've heard addicts say to me, "I'm only hurting myself."  They don't understand that drug addiction hurts everyone, not just the addict or the addict's family. Let's look at some of the financial costs of drug addiction.

There are many costs--health care costs, crime related costs, health administration costs, lack of productivity costs, welfare costs, and birth defect costs, to name a few.

Drug abuse and addiction are a major burden to society

Estimates of the total overall costs of substance abuse in the United States—including health- and crime-related costs as well as losses in productivity—exceed half a trillion dollars annually. This includes approximately $181 billion for illicit drugs, $168 billion for tobacco,  and $185 billion for alcohol. Staggering as these numbers are, however, they do not fully describe the breadth of deleterious public health—and safety—implications, which include family disintegration, loss of employment, failure in school, domestic violence, child abuse, and other crimes.

These figures are from NIDA (the National Institute on Drug Abuse).

The only thing that makes sense financially for the United States is prevention--beginning with the pregnant mother and for her child in preschool, elementary school and middle school. Every cost-benefit analysis of prevention vs. treatment points toward prevention.

What Causes Drug Addiction?

Most of this article is from NIDA  (the National Institute on Drug Abuse)

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view teenage drug abuse as a parenting problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower.It's a brain disease.

Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by overstimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high—an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences—in other words, to become addicted to drugs.

Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

·    Biology

The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.

·    Environment

A person’s environment includes many different influences––from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.

·    Development

Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decisionmaking, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.

National Institute on Drug Abuse