Let's start here.. What do you need?
The treatment industry for behavioral health and substance use treatment is tremendously hard to navigate even for those of us within it. So let’s start here: What services do you need? To answer this question it is helpful to explain a concept that most professionals in this industry rely on to help determine the right “kind” of care for clients: The Continuum of Care. Then, the next important consideration will be the coverage your healthcare plan will provide.
Deciphering the Continuum of Care
Project Courage offers services that cover the first three points of this continuum, covering weekly therapy all the way to intensive outpatient.
To truly get a sense of what level of care a potential client needs, it's ideal to have a thorough assessment completed by a professional who specializes in substance use disorders. However, we’ve often found that our clients and their loved ones have a deep sense of the level of care they need and typically they’re right. Unfortunately, insurances often require an assessment to be completed by a qualified professional before they will authorize payment for services. At Project Courage we are proud of the assessments we provide for our clients. We feel we've truly found a balance between conducting an assessment that provides sophisticated diagnostics while simultaneously honoring the human experience and not pathologizing the individual.
This leads us to the next important consideration when you’re looking for help: will my Insurance cover the costs?
Making Sense of Insurance
1) Is my health insurance plan an out-of-network plan or an in-network plan?
In-network plans (often referred to as HMO’s) are plans that insurances offer which give their members a “network of providers,” (a list of doctors, dentists, psychiatrists, therapists, etc.). In-network plans mandate that their members must stay in this network of providers in order for the costs of such services to be covered by the insurance. Alternatively, out-of-network plans will supply their members with a similar “network of providers,” but they will also allow members to go outside of this network and still provide some coverage for the cost of associated services. Out-of-network plans provide their members with more discretion in who they access for services, and, as one might expect, typically the costs to obtain an out-of-network plan are higher.
2) If I have an out-of-network plan is there a deductible, and if so how much is it?
One of the ways out-of-network insurance plans will try to encourage members to remain “in-network” is to establish a deductible; an amount of money that the insurance will require the member to pay out of pocket before they will begin to cover the costs for any out-of-network services. Deductibles can range from $300 dollars to $12,000, so this is an important piece of information to obtain before you go “out-of-network.”
3) If I have an out-of-network plan what is the “co-insurance?”
In addition to deductibles, insurances will also attempt to encourage members to remain in-network through co-insurance. Co-insurance is the amount that a member will have to pay out-of-pocket for services from an out-of-network provider even after having satisfied a deductible. Typically co-insurance is reflected in a percentage of the cost that the insurance will cover versus what the member will cover and often ranges from 50%-80%. For example, if an individual as an out-of-network insurance plan with a $500 deductible and 80% co-insurance, and they were getting individual therapy that cost $150/session, then they would need to pay the first $500 to cover the costs for their therapy. After that the insurance would cover 80% of the $150/session costs, leaving the individual responsible for the remaining 20% or $30.
Obviously, this can be quite cumbersome to determine. So, when potential clients call Project Courage, we provide a service called a Verification of Benefits at no charge. This means that we will take on the burden of contacting your insurance and determining all of this information so that you can get the help you need with confidence.
Once the individual is armed with an understanding of the right level of care and the benefits they can expect from their health plan they’re in a much better place to get the help they need. At Project Courage we want to help you in both of these areas. We’re very sensitive to the fact that when people are calling us they need help, and the last thing they want is to feel overwhelmed by the daunting task of trying to navigate the maze of behavioral health and the addictions treatment industry as well as their insurance benefits. That’s why when potential clients call in we let them know we’re here to help whether that’s with services we can provide or getting them in touch with another provider. We stay involved until out clients are in good hands.