insurance coverage for substance use, addiction and mental health; parity, denials and tips for getting treatment covered, with Virginia Holleman
Host: Brenda Zane, brenda@brendazane.com
Instagram: @the.stream.community
The Stream Community: a modern, digital respite (not on Facebook) for moms of kids experimenting with or addicted to drugs or alcohol, in treatment, or early recovery
Free ebook: “HINDSIGHT: 3 Things I Wish I Knew When My Son Was Misusing Drugs, by Brenda Zane. Download here
Guest: Virginia Holleman
Show Resources:
Virginia’s top 5 tips for handling an adverse decision by a health insurance company:
1. Don't accept a denial/adverse decision.
2. Educate yourself on your plan benefits and the federal parity law, as well as your own state's parity law.
3. Communicate with the health care provider and insurance company.
4. Appeal, appeal, appeal!
5. Submit complaint(s) to the appropriate government regulatory authorities (state insurance department, attorney general's office, etc.)
General information on the federal parity law:
https://drugfree.org/article/what-is-the-mental-health-parity-and-addiction-equity-act/
https://www.parityregistry.org/
https://www.lac.org/resource/health-insurance-for-addiction-mental-health-care-a-guide-to-the-federal-parity-law
Understanding your rights/things to do before and during treatment/signs your insurance company is violating the parity law:
http://parityat10.org/wp-content/uploads/2019/03/1.-Parity-at-10-BASIC-v3.1.pdf
http://parityat10.org/wp-content/uploads/2019/03/2.-Parity-at-10-WARNING-v3.1.pdf
https://www.lac.org/assets/files/Red-Flags-Tool_poster.pdf
https://drugfree.org/article/how-to-properly-document-your-contact-with-your-insurance-company/
Help with appealing adverse decisions:
Https://drugfree.org/article/i-just-got-denied-coverage-now-what-how-to-file-an-insurance-appeal-for-substance-use-disorder/
https://www.nami.org/getattachment/Advocacy/NAMI-Advocacy-Actions/2021/Advocacy-Resource-on-Parity-and-Appealing-Denial-o/KF-NAMI-Appeals- Guide-April-2021-final.pdf
SPEAKERS
Brenda Zane, Virginia Holleman
Episode topics: parenting, teens, mental health, substance use, addiction, insurance, parity law, treatment
Show Transcript:
Brenda 00:00
Virginia Welcome to hope stream. This is a conversation I've been wanting to have for a long time. And so I'm thrilled to have found you through our common passion of coaching parents with the Partnership to End addiction. So thank you for being here and making time on this Friday afternoon for me.
Virginia
Well, thank you for having me today. It's really a privilege and honor to be here on Hopestream.
Brenda
Yes, thank you. Well, this is a topic that is near and dear, I think to every single parent who has a kiddo who's gone to any kind of treatment. And I had to do like a little meditation moment before I started this because I get so riled up about that I had to be like, okay, I can have a calm, rational conversation about this, because it just seems like it's always a battle. It's always a fight. And my goodness, if we're not already fighting hard enough for our kids, like we needed something else to fight about, right?
Virginia
Absolutely. And to be honest with you, I had to have a bit of meditation moment myself, because when I was preparing for this interview, I was getting all riled up every time I look at this, anytime I prepare for anything I do, it makes me so angry. And so I'm with you, I had to just meditation and calm myself down because it is so frustrating
Brenda
It is, so for the listeners, if your blood starts to boil, just hit pause, flip over to like insight timer, or listen to some beautiful music, and then come back, we get it. It's frustrating. It is frustrating, it's unfair. But hopefully, by the end of this, you will have a few more resources, you're going to feel a little bit more empowered by all the work that Virginia has done and that she's going to share with you. So there is hope, as always an hope stream. Why don't we just start out Virginia have you give us some background on how you got to be talking about what we're talking about today? A little bit about your family and your story?
Virginia
It was a little over three years ago, and my son will who was 17 years old at the time, was spiraling out of control. using drugs and alcohol, he had pretty much dropped out of his senior year of high school. And so while my son was spiraling out of control, I was also spiraling out of control, with my obsession to get my son under control. So we were really on a parallel path of destruction. And fortunately, I was able to hook up pretty early on in this journey with a local support group, parents helping parents and national organization now called course the partnerships in addiction, where I started to learn the skills and tools to move my family in a positive direction. So with the skills and tools, we were able to navigate will to see an outpatient drug and alcohol counseling.
Virginia
And in the fall of 2018, my son's outpatient counselor told me that if we did not get into residential treatment, as soon as possible, he was likely going to end up in jail, or dead. So I started doing my homework to see if insurance is going to even cover residential treatment, because I knew that was fairly expensive. I'm an insurance lawyer. And not only that, but I'm an insurance coverage lawyer. Now I don't represent health insurance companies. I represent property and casualty companies, your homeowners, insurers, automobile insurers, but I didn't figure it would be much different. And I knew that if you want to see if something is covered under your homeowner's or automobile insurance policy, you just look it up in your insurance policy. So right, simple, right. So I did that I went and I found my policy booklet and looked for coverage for treatment of addiction. And voila, right there. My benefit booklet had a title called drug addiction, Substance Abuse and Alcoholism. And under that title, there was just one sentence. And that booklet said, your benefits for the treatment of mental illness include treatments for drug addiction, Substance Abuse and Alcoholism. So I thought, great, we are in the game of gut coverage. Let's just move forward.
Brenda
Good news.
Virginia
Yes, so I thought. I figured it was not a complex issue. So I then I researched treatment facilities, especially those that were providers in my insurance network, and contacted a treatment facility that we chose ahead of time. And that the treatment facility did what they needed to do with contacting the insurance company making sure there was coverage. You're doing all they normally do ahead of time. And the facility told me I just needed to pay my deductible upon admission, and I was good. So everything was great. So on November 7 2018, my son in a residential treatment out of state, and we took him down there. And my husband and I had felt an immediate sense of relief. We knew that our son was safe, and we were thankful that we were able to get him into treatment before tragedy struck.
Brenda
And can I ask was this a wilderness program or just like a residential treatment program? What kind of a place was he in?
Virginia
It was not a wilderness. It was a facility for adolescents and young adults. Okay. Yeah. I don't know what ages but adolescents and young adults,
Brenda
Okay. Great. So all's good son's in treatment ensures is going to cover it, Mom and Dad are saying, whew!
Virginia
yes. Ready to return to some normalcy, normalcy to focus on my career as an insurance lawyer because I had been neglecting my job been neglecting my other family members. And I needed to get back to to life and self care. Self Care is always good for about two days. And then two days after we left will at the facility. I was blindsided by my insurance company. The director of the treatment facility called me and told me that the insurance company was denying coverage for wells treatment. He said the basis of the denial was the fact that my son was not homicidal, or suicidal. No, I was shocked. I didn't see anything about homicidal or suicidality being a prerequisite to coverage in my benefit booklet. So all that peace, really, that I had for a couple of days was gone in an instant, to where they say they were going to just let him go.
Brenda
Like, were they saying, come pick him up, or you've just got to write a big fat check.
Virginia
They said this was on a Friday, Friday, Friday, like a three o'clock, you know,
Brenda
of course, this never happens on a Monday at 11 in the morning,
Virginia
And you know, they didn't come out right out and say we're going to kick him out. But you know, he, you know, he said, we have to have payment. And to be real honest, I was in such shock, that after he told me the basics, I'm not 100% sure what he said at that moment, because I was in shock. But in conversations in the next few days, with a treatment facility, he was telling me that, you know, I would need to come up with some money for at least a few weeks of treatment till the insurance company, maybe they would reverse their decision or, or something. But, you know, I understood that if I wanted my son to stay, I needed to come up with at least two to three weeks of money of funds for treatment. And I didn't have those resources, you know, just instantly at my disposal,
Brenda
right? Not many people do.
Virginia
Yeah, that's not something that you, you know, when in your budget you put in there, I scrambled and pulled from as many resources as I could. And I was able to come up with money for a few weeks of treatment that the facility required from me. So in this time, I started to dig in and do research. I was aware that there was a federal parity law, but I really didn't know the intricacies of it at all. I knew that co pays had to be the same for mental health providers as they do for regular medical providers. But that's about all I really knew. I certainly didn't know that claims for treatment of mental health and substance use disorders were not paid the same as other health claims were paid, despite federal law that said otherwise. Nor did I know that the federal law that existed was not enforced.
Brenda
I feel like they picked the wrong mom, like, wait a minute, this is an insurance claim lawyer wrong mom to mess with.
Virginia
You got it. So just as I educated myself with the disease of addiction, when I discovered my son was struggling with substance use, I educated myself on the federal parity laws and what I could do to get coverage for my son's treatment. And one thing I learned that while it was recommended that my son stay in residential treatment for at least 60 days, the treatment facility only requested pre authorization of a handful of days at a time. So that was good in that I was able to jump in and speak with the company care coordinator for my insurance company early on in the process.
Virginia
So while the first 10 days of my son treatment were completely denied. And I paid out of pocket for those. When the treatment facility requested the next increment of days to be pre-authorized, and it was denied, I was able to contact your coordinator. And then I was actually successful in getting the decision reversed at that point in time, because by that point of time, 10 days, I had done enough research and an educated myself that I was able to, to make a change, right. And this actually happened several times, I think, for the 67 days, my son was in treatment, there were five or six different claims.
Virginia
And the days that they requested pre-authorization for, which is what the insurance company acquired, they were never the same amount of days, it wasn't like one week at a time, there was some days it was five days, three days. And that actually is often a parity violation, which we'll probably get into, in more detail a little bit. But often insurance companies require more restrictive pre-authorizations for mental health and substance use disorder claims than they do for regular medical services clients. So but in this instance, it actually played to my advantage, because I was able to get in and make some changes early.
Virginia
So like I mentioned throughout this process, we were able to keep my son in treatment for 67 days, which is that was congratulations. That is that's a win. Now it wasn't, you know, it wasn't played paid for by any means. They were, you know, stepping it down and paying it at reduced rates and I op rates and other different rates of residential treatment. But my phone calls really made a difference. And I think it made this case not just a number for the insurance company and the treatment facility, utilization review people, those are the people who mess with this insurance staff. But when I contacted the Customer Care Coordinator, I think it it lends less humanity to the situation. And after all, ultimately, these are people to write and I when they heard about a child, Mom and crisis, the suffering, I don't know, I like to believe I talked to their heartstrings a little bit. And that might just be my perspective. And they may have made decisions for a whole nother reason. I really ultimately don't know. I just know that changes started to happen.
Brenda
Could we pause for one second, just have you educate us on what the federal parity law is? Because I have a feeling a lot of people have never even heard those words. So what is that? And then, more specifically, what does it mean when we're talking about mental health and substance use treatment?
Virginia
So the federal parity law requires that health plans that provide coverage for mental health and substance use disorder must cover mental health and substance use disorder treatment, in the same way that they cover treatment for other diseases. The law does not require health plans to cover mental health and substance use disorder. But what the law says is that if they do provide such coverage, the coverage must be the same.
Brenda
Which the same those two words the same? I think it tricky, because what is the same? Right?
Virginia
It's a good question. And it's a $64,000 question. I'll give you some easy examples. co-pays, you have co-pays for your family doctor when you go in and get a checkup for regular medical services. And you might have a copay if you go see a psychiatrist or any other mental health professional. And those co-pays must be the same. Under that same insurance plan. Or for example, sometimes like in the past, I had a copay for my family doctor, but services for payment and coverage for any mental health provider was subject to deductible. Can't do that. You can't do that under the federal Parity Act. So that is a very simple, one simple explanation of what must be the same. There's, of course, many, many, numerous other ways that coverage must be the same and they get a lot harder and more complex. But that's just one simple example.
Brenda
Okay. And I could see where things would start to get blurry when you're talking about like a residential program is the copay every day of the residential program because you're basically there every single day or is it a one time thing so I could see how that would be really confusing. And I'm glad that you mentioned there's that difference between a copay and a deductible. Because for people who don't really deal with insurance very often, I think this just all gets lumped together as a confusing topic. I don't get it. I guess I'll just write a check. I don't really understand what they're billing me for. At least that's where I Started out. And that's not a really empowered place to come from when you're when you're dealing with a lot of money.
Virginia
You're absolutely right. So it's very complex. And, and it helps to have a basic understanding of, of how health insurance plans work, before we even get into the federal copyright law. So most health insurance plans not and when I'm talking generally about private health insurance plans, and I'm not talking about Medicaid and Medicare, because those are really in a whole different category. But most private health insurance plans have a summary of benefits may be a few different pages, but they kind of start out with, you know, here's what your co pays are, or, you know, this, these types of services are subject to the deductible. So that's something that you want to look at, early on, just looking at what the benefits are, in general, and get a feel for how this works.
Brenda we need to get smart, we need to actually open those PDFs that they send us that we just file away in the folder that says, someday I might look at this only if I really need to, that's the PDF or the booklet that you want to get out. If you're dealing with this and start reading, they can be very intimidating, because they're usually really long and full of words that are really confusing for the normal average show person. So get ourselves educated. So if there is this federal parity law, and now we understand a little bit more about it, if that exists, why do so many of us like why did you get the phone call that says We're very sorry to tell you that your son's treatment is not going to be covered? How does? How do those two coincide?
Virginia
Well, while the law looks great on paper, the law actually has little to no enforcement provision in it. And so the law actually relies on consumers like me to raise issues with compliance with the wall. And so of course, the problem, lots of problems with that. Number one, most consumers, like you said, I'm not even aware of the law, or the rights the law affords, or how to exercise those rights. I'm a fact A survey conducted a couple of years ago found that only 4% of Americans knew about the federal parity law, right? I 100% believe that? Absolutely, yeah. So that's, that's one huge barrier. The second is consumers usually don't have access to the information they need to get the relief they need.
Virginia
And then Moreover, on top of all of this, those consumers, those family members are usually in crisis. They are seeking life-saving care for their loved one, and are unable to navigate the complex and time-consuming process required to deal with these insurance companies. Right. And then on top of that, you have the stigma and shame that many parents feel. And if they have not sought help, they may feel too ashamed to do anything. When I say they've not sought help. They're not working with counselors or support groups to realize that, that this is a disease like diabetes and like cancer, and that there's no need. There's there should be no stigma and shame. But they don't know that yet. I didn't know that until I started getting support. I was embarrassed about all of this. Yes. And I wouldn't tell anybody until I started wanted support groups, right? So they make fun of parents, family members may feel there's a good reason why there's no coverage, you know, and not even argue with it. So that all of those things make it a huge burden and barrier for consumers to fight the insurance companies on this. And the big problem is that insurance companies know all of this. They know it and they take advantage of the consumer.
Brenda
Yes, yes, yes to everything that you just said 100 times over. And I was worried that if I called my insurance company, so I had insurance through the company I worked for, I was kind of worried like, will my employer know, if I'm calling I don't know how this is how ignorant people are right? Like we don't know, like, I'm thinking if I call and I am asking questions about drug and alcohol treatment, is somehow my employer going to know this. And either they're going to think it's for me, or they're going to know, it's maybe it's for my child, and how is that going to impact people at work? I mean, there's just a million things that go through your brain. And so, yes, I think it's hard to reach out. And I think the other thing that really got to me was I would have some people on the phone who were amazing and helpful, you know, those customers hire people. And then I had some people when I would call that you could just hear in their voice that they thought I was the scum of the earth because I was looking for drug and alcohol treatment for my child. And that's not helpful when you're in that position. So yeah, lots and lots of barriers.
Virginia
That's right. That's right. So, so basically, there's just no enforcement. And that's why we have the problem that
Brenda
Okay, so no one's enforcing this, if an insurance company is not following the parody law and doing what they're supposed to do, it's really up to you, as the user of that service, that consumer to raise the red flag, is that right?
Virginia
That's right. And in this instance, that's what I mean, with my son in his situation. That's what I did. And that's why I think it's important that we all I try to educate everyone who was born through this, or you know, somebody who's going through this, about all of this, because if you don't know you, I mean, you don't know. And so, education is really key at this point in time. Now, I will say that there, there is progress, there's movement to hopefully one day get the insurance companies in compliance and have good enforcement tools. But it's slow. There's movement on both the national and the local levels. But it's gonna be a long time before we get there. So unless and until we do get there, it is up to the families to fight for what is right, and for what they entitled to.
Brenda
And you're talking about as we both known as everybody who's listening knows, you're so exhausted from just fighting this fight every day that the thought of fighting a one more fight with a gigantic corporation is just like, No, I'll just pay it.
Virginia
It is emotionally exhausting. And I was when I was going through this, it was like I was in crisis again. And, you know, when I said I had success with the insurance company, I did, but it was not easy. It was a battle. You know, I was having every time I would call, they would give me a different reason for the denial. Like I told you the very first time that the treatment provider said that my sense denial was because of homicidal. And he did not have homicidal suicidal tendencies. Well, the very first time I called the insurance company and asked them why they were denying coverage. They told me that it was because he was only using marijuana. And that's not covered. Well, first of all, that's not a legitimate grounds.
Virginia
Number two, it's not true. Um, he just had my son happen, he used other substances other than marijuana. But for the period of time, he there was a week before he went to treatment where he didn't have access to those other drugs that don't stay in your system very long. So when he got to the treatment facility, the only thing he tested positive for was cannabis marijuana. Products weren't in his system a longer and I tried to explain that to them. And they didn't care, but little things like that. It's, it was emotionally exhausting. And I wanted to give up so many times. But then I realized, I mean, if I can't do this, an informed consumer and an insurance coverage lawyer, who can and I want it I vowed to get to the other side of this, and to help other families because I didn't want anybody else going through what I went through. Now. I know, it's impossible for me to help everybody in the world. But I just thought if I could just help one person, two families, three families, however many. That's, that's better than that's
Brenda
And maybe that's, you know, that's just part of your legacy is you're going to be able to help people because the financial devastation I know all too well. I know so many families that sell their homes, they sell their cars, they sell their boats, they sell everything they have the 401k the other kids college fund. It is it is tragic, the financial devastation that occurs when you when you have to do this, and you will have people who will say, Are you really going to do that to pay for his fourth treatment program. Whereas if that was a fourth round of chemo that wasn't covered by insurance, I'm pretty sure nobody would say that to you.
So there is a lot of stigma, like you said, and, and questioning and lack of understanding from people when you're going through this. And so it sounds like there are lots of different reasons that you might get from your insurance company about why the why you're being denied. One I know is that whatever whatever you're asking to be paid for. They'll say it's not met necessary. So how, how does an insurance company decide that like, how does some guys sitting in a office park in Nebraska, tell me what's medically necessary for my kid who's in a treatment program in the desert in Utah? Like how does that work?
Virginia
insurance companies have sets of standards of care that they use to decide if they will pay for medical services. Now, the law requires that these standards of care must be generally accepted among mental health and substance use disorder professionals. And there's no single source of generally accepted standard care. The most familiar and widely used standard of care is a Sam, the American Society of Addiction Medicine standards, but there are others. But many insurance companies have their own standards of care, that are not generally accepted by mental health professionals, and are instead decide designed to line the pockets of the insurance companies to make them money.
So they look to these own internal guidelines and criteria that are very restrictive so that they can make money and deny claims. And so that's the underlying reason for many denials under the guise of medical necessity. Now, recent court case, sir, in California said insurance companies cannot do that, that they must follow generally accepted standards of care. So we will see if insurance companies start to follow General, separate standards of care that it's still this law still, you know, it only applies to these certain individuals, it's being appealed. And so we'll see where that goes. But there's also instances like my situation where the insurance companies theoretically use generally accepted standards of care, but they don't follow the standard.
So with my insurance company, that the one that denied my son's claim, they actually set up they followed the ASAM standard of care. Yeah, when you looked at, you know, when I finally when I was going through all the appeals and had, you know, requested all the, the letters and the reasonings and the basis for the decisions, and I compare those to the ASAM standards and criteria, it was clear that they were not following the ASAM standard. And I ultimately pointed this out in my appeals, which I was able to prevail on mostly, but that's how I won most of my appeals.
Now, mind you, I, in order to get there to do these appeals myself, I had to purchase the same standard of care for $200, I had to use really my knowledge and skills as a lawyer to draft what really ultimately was medical necessity letter, which, that's probably not within the purview of a lay person, or even a lawyer, those letters are supposed to be written by professionals. And while I did have some letters from the treatment facility, you know, talking about how my son needed to be in residential treatment, they didn't do an analysis of the factual reasons why compared to the ASAM standards care.
So when I was writing my appeals, I was doing all of this. And I was doing it because I had some skills in that area as as a warrior, the average person who doesn't have those skills, is not going to be able to do that, unless they hire a lawyer. And I will tell you that it's difficult to hire a lawyer, unless you have a lot of resources and can afford to pay a lawyer by the hour. It's not profitable for us lawyers to take cases like this is complex, I won't get into it all. But bottom line is, it's very difficult to get help, right?
Brenda
And when you're looking at your bank account that is draining quickly. And then you look at well, should we hire a lawyer to to do this? You're like, you know what, I gotta use that money to pay to keep my kid in treatment another week or another month, or whatever it is. So well, it's this is why we needed to have our Zen moment before we did this episode because I can feel my my blood boiling. Our son's treatment was also denied for the most part, and I hate and I hear that, in particular, around wilderness therapy and around residential treatment, because what what will get covered is the one hour of therapy a week that your child might have while they're in wilderness, but they won't pay for the equipment that they need to just sleep outside, or their food or anything like that same thing in a residential treatment center or therapeutic boarding school. You know, maybe the therapy for the hour is covered and not the analysis. And I hear people compare that with my kid was in the hospital with leukemia, they wouldn't just pay for the leukemia, you know, drip, whatever they're getting, and not pay for the food that the hospital is giving them. So is that a parody thing? Or is that different?
Virginia
It is a parity thing. And there are actually many cases in litigation right now, you know that everything has to be the same. So, you know, they, you know, they look and at, you know, just because, you know, this is a little bit different than how leukemia might be treated. You know, that doesn't mean, we'll be denied. But you're right, insurance companies, they're just so scared of wilderness. They think it's experimental, although it's been around forever, but you have to compare, you know, in the plan, you have to look, and this is where it gets real, complex, and nuanced. But you have to look at the plan and see what is provided for medical services. And, you know, there has to be the same coverage for behavioral health.
I'm hopeful that someday that this will be remedied because I do wilderness therapy. And there's some great facilities out there, and I believe it should be covered. And like I said, there's some litigation out there, I don't know how long it'll be before may have some answers. But you're right on target with how you compare the Leukemia drip to the one hour therapy session, you know, those leukemia patients, they get the room import paid for, they get to sleep in the hospital and get that paid for, just because your loved one is sleeping, you know, in a cabin, perhaps, and doing experiential, you know, exercises outside, you know, your leukemia patients also probably getting some physical therapy at the hospital, same thing. So you're absolutely right. And it's something that it's a huge problem.
Brenda
I'm thinking that you could probably give us some tips on how to get smarter about this short of becoming a lawyer like you are. Because I think that's probably not going to happen. But let's talk first about parents who might have a child who's in treatment right now. So my kid is in wilderness therapy or in a residential treatment center or, you know, a 30-day program, what should they be doing or watching for, in that case, where you've already got a kid who's in treatment, and you have, like you said, not medic, Medicaid,
Virginia
employer sponsored insurance is generally what we're talking about. I'm also also not just employer sponsored insurance, but also insurance you might get on the market exchange, under the Affordable Care Act, that would be the same as well. But so what's that Wait, you've already, you've read your plan, you've gathered your documents that we talked about earlier. And one thing I want to mention, you talked about opening up that PDF, sometimes it's even a little bit harder to access those, sometimes, you have to go online and find those documents, they're not easy to find. So they make that difficult just to access those, but that you make sure you know, get your plan benefits, look them over, make sure you have coverage for mental health, and substance use disorder treatment.
Not all plans do most plans do, but not all it now if your child is 18 or older, and if they are agreeable for you to advocate for them on their behalf with regard to this insurance coverage, it's important to get written consent under HIPAA and all that to number one communicate with the treatment facility about any and all insurance decisions. If your child is under 18. Not a problem. But if you're 18 or older, you need to do that, whether in treatment, I would recommend talking to you are people that utilization review or sometimes utilization, utilization management, those are the folks from the treatment facility whose sole purpose is pretty much to get make sure there's insurance coverage they communicate with the insurance companies they provide the insurance companies, the documents, they request, etc.
So early on, I would contact them and say, Hey, you know, please let me know, please put me in the loop. If there's any issues with the insurance company, let me know. So I'm can be informed of any potential negative decisions. So I can jump in and help and they might poopoo your way and say, Oh, we got this, you know, this is what we do. We don't need your help. But my experience and I've seen other people's experience be that a parent jumping in and you know, simultaneously, at the same time the facilities is advocating for your child with the insurance company. You can also advocate with customer care people as well. Same time, right. Okay. So and if there was a denial in part or in whole, those of you our folks will likely submit a provider appeal. And I would ask your people to you know, let you know exactly what the basis is. In my case, the basis that the interest can be told the treatment facility was different than what They told me the first time a sec Tommy, I got all sorts of different reasons, contact the treatment facility and get to know those people. Also, your insurance company will usually have a form called designation of authorized authorized representative, or appointment of authorized representative. And if your child is 18 or older, and is agreeable to you helping them out on this, have your child sign this form before they ever go in to treatment. And that will allow you to communicate with the insurance company about this otherwise, they won't talk to you, your child's adult and and they won't talk to you.
Brenda
And they are usually not in a good headspace to be dealing with things like insurance. So I think that is a huge golden nugget of information. That however you have to do that. Make sure you do that. Because as we know, our kids are not in a good place when they're in in this period of their life. And if they're in a program like this, so the more control that you can have, because I found that too, I lost control. Because my son was 19 when he overdosed, so super duper important to get absolutely
Virginia
I my son was actually 17 at the time, so I didn't face these issues. But I have seen seeing the difficulties encountered for those over 18. So you're right, it is very important and trying to get that done ahead of time, if at all possible.
Brenda
Just a quick question, is that something because I, the reality bell is ringing in my head to say okay, most times, kids are not agreeable. They're not willing, they're probably not going to be like, Oh, sure, Mom, here, let me sign this piece of paper is there and maybe this is a different type of lawyer to ask, but I've heard that there are a want to call it a medical power of attorney or something like that, that you can get when your child's in a good place in a better place in a sober moment. If you can get that that that will allow you to make medical decisions. Am I crazy? In my Do you know what I'm talking about?
Virginia
I do know what you're talking about as far as medical power of attorney. And that would be good, too. That would be good, too.
Brenda
Yeah, just because I know, when you're in a situation, you know, sometimes you're not even with your kid, if they're over 18, a lot of times parents are living in an in another state. You know, they just don't have access to either physically or even mentally, the ability to get something like that signed. So I guess the net of it is if you can get that signed, get it signed.
Virginia
Yeah, but a medical power of attorney still you're still gonna have to have your child signing? Doesn't have to have them give that power to Yes. So. And then, of course, there's other issues involving the courts where that's, you know, like involuntary holds and things like that. That's a whole nother issue generally. Right.
Brenda
Okay. So just quick review on if your child's currently in treatment, get to know the people at the treatment program who you are people who are responsible for all the insurance. And I think you just have to be politely assertive, right? Like,
Virginia
and that's the balance politely assertive because you want to go when they're charging. And you want to I mean, you have to restrain yourself. And you have to remember that the ability to dodge is not coming to you right now. Honey, what's the holdup? Oh, yes,
Brenda
I know what you're talking about. It's not coming to me. I know. Well think of it. Yeah. But yes, politely sort of. I love how you say that. Okay. Yes. Great. So that's if they're in and then just keep in touch with those folks. So that if they are if they do start getting the denials, that you are aware, you are informed? And I think, yeah, you just have to, you really have to just steal yourself for a fight. And just know that it, it could be a fight. And it's not because you're a bad person or your child's a bad person. It's just the way the system is right now.
Virginia
Right. And also at the same time, you need to be looking at paying attention to your mail, and it'd be a regular us mail or email, or accessing online. But ultimately, you'll be receiving correspondence from the insurance company to know that is if your child is under 18 or if you've gotten authorization for them to communicate with you so because once insurance companies start sending new those that correspondence you need to read that carefully find out what the basis of their denial or decision is. And because there are timelines, there's often timelines with their decision deadlines. So you need to read all of that very closely.
Brenda
Right? Don't look at it. Think it's going to be bad news and stick it in a pile somewhere like I did, like an open or something. open them up. Yes. Okay. And then what about what if you're in business Where you are thinking about treatment, you are, are starting to build a plan because you can see this might be coming in your future. What are some of the things that we could be doing in advance or be at least be aware of or preparing or researching, so that we might prevent some of these hiccups in the long run? Yeah.
Virginia
Well, to educate yourself, that that's just huge, really educate yourself on the federal parity, law, medical necessity, and there are a lot of resources out there that are just a huge tool beneficial. And that's how I educated myself, the Kennedy Forum, Patrick Kennedy, he is the son of Ted Kennedy. And as many people know, that family struggled with addiction for many, many years. And Patrick Kennedy as well, he was also in Congress. And he is the one who actually co authored the federal Parity Act really interesting. Yes, he is. And now, but he also realized that there were many problems with the Federal Parity Act. And so he has established this foundation called the Kennedy forum that is dedicated to advancing this law and ultimately making it enforceable, along with many other mental health and substance use disorder advocacies, he is an incredible champion for people with mental health and substance use disorders.
Brenda
Good to know. So we'll put this way, we'll also, Virginia is going to give me all of the resources that she has. And I'm going to put those in the show notes for you. So be sure and go to the show notes, Brenda zane.com, forward slash podcast, and then scroll for this episode to download all of that stuff. So it'll all be there for you.
Virginia
The partnership in addiction also has some fantastic articles on, you know, just step by step, what do I do? So lots of different articles, and I'll also provide those to you as well.
Brenda
Okay, so we're going to get ourselves educated, is there anything sorted from a practical level, obviously, and I've said this in episodes before, find an advocate at your insurance company, at least I found, like I said, there were some that were great, some that were not so great. But I did just keep calling, because I have found that the people who answer the phone genuinely want to help you. It's the people 18 layers up who might deny your claim, but I did find for the most part, the people on the phone really wanted to help me. And when you find a good one, get their name, find out what their extension is. So you can call them back.
Virginia
Not only that, but every time you talk to somebody with the insurance company, write down their name, the date, the time you talk to them, and ask for a reference number, they will usually have a reference number they can provide you with and you know, try to, you know, write down as much as they said, because some sometimes you might be able to use that in your favor. So,
Brenda
right, that's good, because it gets thick. I remember I had a file like three inches thick, just all of this. So. Okay, so that's really good. And I think your story about how your son hadn't had access to any other drugs in that week before. Just to know that whatever shows up when they do go into treatment may or may not be the reality of what's going on, right? That's right. Absolutely. Yes. Yeah. Okay. Wow, so much good information there. And I think, a huge amount of patience with yourself. I also say, and I don't know, if you while you had the resources, mentally, I guess to do this, I know, it's physically exhausting to but I've told people in previous episodes that people often want to help you when you're in this situation. And this is one of those things, they might not be able to talk to your insurance company, because they're not going to allow that. But they can help you with the organization of all this material with documentation, whatever it is, if you if, if you're fighting the fight, and you're already exhausted, and you have people who want to help, this is a great place to have people help because you can get confused. Maybe you've got somebody in your family or friend group who does understand insurance, pull them in. So just one of those really good places where you can actually accept some of that help and get it again, they're not going to necessarily talk to your insurance company, but a lot of the other background stuff they can do so just a tip that I learned. Yes, absolutely. Yes. Yeah. Well, if I could give you a billboard in downtown Oklahoma City, and you could say anything you wanted to about this topic, what would your billboard say?
Virginia
My billboard would say, mental health plus physical health equals Whole Health, demand equal insurance coverage for treatment of mental health and substance use disorder. And I'll have a website and a phone number.
Brenda
Nice. I love it and every single person would be calling because I feel like
Virginia
it would be for every state, every city, as local as possible would have that because the more local You are the, you know, there's the more intimate and uncomfortable and probably more help you'll get.
Brenda
Yes. And so we are going to list resources for everybody in the show notes. Is this something that you work on personally, like, I don't want to give out your email your phone number, because I don't want the whole world calling you. But what how do you work in this space right now? Kind of what's your role?
Virginia
Well, this is just something I do as a volunteer effort. You know, I'm still in the business of property and casualty, I represent homeowners and automobile insurers. And so I just want to be able to help people. So this is still all in a volunteer capacity for the most part. Now, sometimes, you know, I've had people say, Well, I want you to handle this appeal for me. And I have done that for a fee. But what I really like to do is just guide people and, and help them navigate to all these resources.
Brenda
I hated. Being where I was, I knew I wanted to help people that were in the same place as I was, it is a painful place to be, it just adds a layer of complexity. And it can add shame because you don't always get treated well, when you're fighting for this. So I think what you do is amazing, this has been so helpful, I think people are probably going to listen two or three times just to go back and grab all of those interesting ideas about what you can do.
And I think what I love about what you're saying is you can be a more empowered, I put an air quotes, healthcare consumer, because I hate that language, because that's definitely like healthcare lingo. But it's true. And he really do have to fight an advocate, just like you do in all other areas for your child. Yeah, this is another area where you have power, you actually do have power, it doesn't feel like it a lot of the time. But we can make noise. And we can make this change. Yes, absolutely. Well, we will put everything in the show notes. I will not put your email or your phone. I don't want you to get inundated, but we will put lots of resources there. And Virginia does coaching. So I will beat the drum again that I always do, which is get yourself a coach from the Partnership to End addiction because they're amazing and free. And it might be Virginia or somebody else who answers that phone. Just to help you through this time. Not necessarily from an insurance standpoint, but just from a coaching parent coaching standpoint. So and you still do that, right? I did. Yes, I do. Yes. And I have to ask how is your son doing today?
Virginia
He's doing great. He's doing great. Our family today, three years later, is 100%. Better? We're not perfect, but I'm not sure I know of a perfect family.
Brenda
Yeah, I haven't met them. So if you do - let me know.
Virginia
Yeah. So um, it's just, it's just wonderful. We have a family culture of love, appreciation, respect, and joy. And to be honest with you, we have never had that even before my son started having problems. And the tools and the skills I've learned in the last three years, mainly from the partnerships in addiction have been incredible resources and have made a huge difference in my life and in the life of my family.
Brenda 49:13
It's so true. And I hear that from parents all the time. They say, you know, what we went through was horrible, or what we're going through is horrible. However, I would have never learned these skills, these craft skills. So if you're listening and you're confused, what we're talking about is CRAFT which is community reinforcement and family training. You can go to drug free.org to learn all about it. But it truly, truly can repair your family move that that person in your family, whether it's a child or spouse or sister or brother, whoever it is to really actually wanting to change. It's that invitation to change models. So I do hear that it's like well, this was horrible to go through and Our family is so much better off for it because we've learned how to be together.
thank you so much. I appreciate the time, the knowledge and your tenacity, if we could all just like, suck some of that from you so that we can keep moving forward with our own battles. That would be great. But I really, really appreciate you being here with us.
Virginia
Well, thank you for having me. It's an honor and a privilege and if I could just have one person, it's just all worth it.
Thank you so much for listening. You might want to download a free ebook I wrote called Hindsight: Three Things I Wish I Knew When My Son Was Misusing Drugs. It's full of the information I wish I would have known when my son was struggling with his addiction. You can grab that at BrendaZane.com/hindsight. Thanks again for listening and I will meet you right back here next week.
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