006 Shelley joins Coach Blu and Marissa Robinson on AddictIIAthlete
"Will my insurance cover addiction treatment?"
This episode is an opportunity that Shelley had to get together with Coach Blu and Marissa Robinson on the AddictIIAthlete podcast to talk about finding the best treatment that is a good fit for you. How to afford it and what are the potential insurance options that may be available. Coach Blu and Marissa have a powerful voice in the addiction recovery community. Their mission is to establish and maintain recovery with individuals and families by promoting lifestyle changes through erasing addiction and replacing it with things of greater value. Addict II Athlete is a nonprofit action-orientated addiction recovery program that will assist anyone touched by addiction and mental health. Those in recovery as well as family, friends and community members. Check them out at Addicttoathlete.com.
The Illuminate Recovery Podcast is about Mental Health, Mental Illness, and Addiction Recovery. Shining light on ways to cope, manage, and inspire. Beyond the self-care we discuss, you may need the help of a licensed professional. Curt Neider and Shelley Mangum are a part of Illuminate Billing Advocates. They are committed to helping better the industry and adding value to the lives of listeners by sharing tools, insights, and success stories of those who are working on their mental health.
Transcript (no grammar): will my insurance cover addiction treatment this episode is an opportunity that shelly had to get together with coach blue and marissa robinson on the attic to athlete podcast to talk about finding the best treatment that is a good fit for you how to afford it and what are the potential insurance options that may be available coach blue and marissa have a powerful voice in the addiction recovery community their mission is to establish and maintain recovery with individuals and families by promoting lifestyle changes through erasing addiction and replacing it with the things of greater value addict athlete is a non-profit action-oriented addiction recovery program that will assist anyone touched by addiction and mental health those in recovery as well as family friends and community members check them out at addict2athlete.com enjoy welcome to the illuminate recovery podcast we shed light on mental health issues mental illness and addiction recovery ways to cope manage and inspire beyond the self-care we will discuss you may need the help of a licensed professional my name is kurt neider i'm a husband father entrepreneur a handyman and a student of life i avoid conflict i deflect with humor and i'm fascinated by the human experience and i'm shelley mancum i am a clinical mental health counselor and my favorite role of all times is grandma i am a seeker of truth and i feel like life should be approached with tremendous curiosity i ask the dumb questions i fill in the gaps athletes take your mark get set it's time for the attic to athlete podcast hey everybody out there coach blue robinson here i want to give everyone a special thanks and shout out for downloading subscribing and really sharing this podcast with anyone who might be struggling with addictions mental health or anything that you might feel could benefit them we do a lot of podcasts on a lot of topics and our athletic director marisa has taken a lot of time to put these on our website attitudeathlete.org if you have questions about any topic go jump on there first because i'll guarantee you after two years doing podcasts we probably have something that will help and of course jump on our news team store we have some awesome uh really good stuff merchandise t-shirts for our extra curricular recovery program so jump on attitude athlete.org and you'll find out all the the neat things that we've been doing there so marissa we have a special guest in today we want to talk a little bit about some some stuff that really i think gets overlooked why don't you introduce our our guest today and uh we'll jump we'll jump head first into this topic all right so we have invited shelly mingham here from illuminate billing i've worked with her three or four years and she has great understanding of rehabs and insurance but also the clinical piece which i love because you are a therapist as well is that right yep that's correct i'm a clinical mental health counselor um i actually started my um internship at a substance abuse treatment here locally in utah and so that's where i started well it wasn't the first place i started but um i started in residential treatment before coming to illuminate awesome so if you wanted to share a little bit more about your experience and yeah your background on how you know about the topic so the main topic we want to cover is like how do you find a good rehab what do you know when you're looking at substance abuse treatment and you know on the insurance side as well as how to find a good one that's yeah because the costs vary so much and you want to be able to get the best i guess bang for your buck literally and so i think shelley can help us all kind of navigate some of the stickier parts of trying to pay for and even find good treatment good help because if you're investing that much time and energy and money into it you should probably go for something that's going to really help your family and not put you into bankruptcy court yeah absolutely and and it's a i mean that's a loaded topic yeah you know and so maybe we'll have to just um address a few different pieces of that i will tell you that um i've been with illuminate billing and we advocate for people that are in substance abuse and mental health treatment which means we work with the insurance companies we're the go-between and so we see all the clinical information for clients and then we relay that information to the insurance companies to get them authorized and paid for their treatment because that's the last thing someone in treatment wants to ask for worry about is how they're going to pay for this you know for getting better they need to focus on getting better which is is which was no which is why our service is so valuable to a lot of facilities even before i started in with illuminate which i've been there since its inception there's been a lot of challenges in getting treatment paid for you know somebody goes through treatment the last thing they want to hear is my insurance isn't paying for any of that right you know that's a huge stress and that can send somebody right back into relapse and so um you know we put a lot of things in place to try and make sure that clients get their benefits covered and and it you know goes the whole gamut i will say that uh that coming into this industry you work with some of the best of the best and some of the not so best right some of the worst of the worst i've seen and and it blows your mind um you know because there can be a lot of money in recovery yeah um you know i was just talking to someone the other day that was working for a a newer facility that they're 60 000 a month i mean that's a you know that's a ticket that's not for your average person right because somebody that's a professional they may not want you know they want to be have anonymity when they go to treatment and so there's a big gamut to be aware of but the you know the average person let's say that i need treatment and that's the thing about substance abuse and mental health that it has no bounds right it touches everybody and so let's say that i get myself into a place where i need treatment where do i go where do i start and i think um i think it's hard because someone in substance abuse has often alienated all those that are close to them right so who do they talk to and who do they trust it's a pretty tight community and so people who are active actively in their addiction typically have others around them who maybe have gone to treatment and you may or may decide that if they're still active in their addiction that may not be the treatment program you want to go to but that's not necessarily true and i think boy i think that there's a lot of things a lot of questions you can ask yourself about what kind of treatment i should go you know should i get residential treatment there's a lot of controversy over whether someone should go into residential treatment where they live there and are there for a period of time yeah like 24-hour day care right exactly or should they start outpatient treatment should they just do day treatment where they're there five days a week you know four to five hours a day you know or even just should i just go see a counselor i know that i've you know in my private practice when i was doing private practice i worked with an individual who was was had an alcohol drinking issue all right and she was struggling with that and she was just a mom you know she was had a career and you know was doing all those things but it was very clear that she was having a drinking issue yeah but she didn't want anybody to know about it right and so that shame piece and and stigma yeah the stigma if somebody knows that um you know then it's out and then it's real right you know mercenary about about two years ago um when we kind of took over some management management at a at a treatment center we were getting coached by a very dear friend of mine coach uh coach paul jenkins right live on purpose and he broke this down for us one day it made perfect sense he said you know as you guys are getting into this he's like what do you truly get paid for and we went through all the aspects of the program and we had some great things on the board but he circled two things group therapy one-on-one therapy everything else is just fluff and it was wild when i started realizing like oh my gosh are we spending enough time one-on-one individually because they have all these other things they've got wreck activities they've got you know um you know personal meditations all this stuff he said but you're only getting paid for two aspects and it really kind of put in my mind's eye the importance of what we're really doing right you could have the most amazing facility state-of-the-art you know gym equipment all these amazing things but really yeah really all that is is fluff to get you in front of a therapist or counselor sort of sort of and and here's the thing that it kind of irks me right is the insurance companies will only pay for what they call quotation marks clinical treatment right clinical treatment is something it's treatment that's done in front of a a master's level therapist you know time in front of the doctor doing med management it's also could be time in front of a sudsy time in front of a wreck therapist processing right but um and any of those kinds of credentials music therapy and art therapy someone who's credentialed in that unlicensed and licensed you can get paid for that because you have a clinical director who can sign off and say yes this is part of their treatment plan so there's more but you cannot um ignore the fact that there's a whole person standing in front of you right and i mean you guys run addicts to athletes you know how important the exercise piece is you can't ignore that you can't ignore um you know doing some of those skills training right how often does somebody come into treatment has no idea how to how to even find an apartment or a place to live and sign a contract yeah those basic life skills to take care of themselves and so you can't ignore that stuff and so it's important but yeah will the insurance pay for it no yeah they won't yeah see and i think that's the dilemma i really do and i think i don't know maybe for for you know humor some of the listeners that don't know anything about what we're talking about let's go over some of that not just the criteria but maybe even the levels of care because it it varies differently like you said should someone start in residential treatment should someone start in you know an outpatient you know i have my own theories my own ideas but those are for another podcast um let's start with if you have a loved one who is on the verge of maybe even getting to the point where death is eminent um and they get assessed everyone starts with an assessment right mercy you do assessments what do you what questions do you ask and how do you place people how do we place people a lot of times you know sadly it's kind of subjective i wish there was better assessments to say abc equals d but there's not so a lot of times information gathering yeah and i try to do my best to be very you know what is best for the client and not you know addressing which a lot of facilities they'll say what is best for us you know if we say that they need residential care then all of a sudden we can get a lot more money than if they need outpatient care um so it's i think it's really being careful on who does the assessment when you find out are they a licensed professional do they work for the facility that you're there's gonna be some you know double-sided issues there if that's where you're at rather than getting just a very general this is what's happening but you start with a non-biased assessment yeah but starting with you know what substances are they abusing how often how long have they been abusing it how is it affecting their life and then you go through multiple things you know as housing an issue job and employment transportation are all of these things and you know kind of rating them and you know issues of you know is there potential for relapse is there serious potential for relapse what's their support system at home like and within the last several years we've created this new scale to rate people used to be part of the you know the dsm coding and whatnot but now it's turned into to the um um the asian exam right asam criteria so if you're looking at someone that's that's that's using to a point where you know death and all kinds of crazy things you know even pregnancy iv heroin use and it looks as though they're going to be needing some some you know some bigger eyes on them they typically range range higher on the asam scale so so shelly if you can talk a little bit about the asam scoring so that people can be aware of what it is like the higher like the 3.5 i think is residential right um there's even higher than that which is like hospitalization um so once you get an asam score because everything that marisa does on the assessment pulls information to score and it's it really is by self-reporting there's not a lot of like medical testing or anything it goes by verbal communication right right well and here's the beauty of the asam is that not everybody that many people that come into treatment aren't telling all the truth right i've noticed that they're gonna minimize or they're gonna make themselves look like they don't have as much of a problem because you know we're stigmatized now we don't you know that stigma of if if something's wrong with me then you know i'm shamed and i'm internally something you know i can't be fixed right and so the beauty of asam is that there are assessments and other pieces so asam is a six dimension criteria you're looking at what are their their withdrawal symptoms and then that's probably what the insurance is going to look at the very most is are they withdrawing do they need medication to withdraw and that that monitoring and is the met is the drug of choice um such like alcohol or benzos to where they're really going to have an adverse effect during their detox they could die during detox so we're going to be looking at that and there are assessments that you can utilize which i think are really important uh siwa score and the cow score once for alcohol ones for opiates how severe are the withdrawal symptoms and this requires you know you might think that you're prompting a client and this is really tough because the client has lived with that kind of withdrawal a whole a long time right yeah and they'll they don't understand just how uncomfortable they are and how sick they are they don't recognize what normal is when you ask them you know how's your sleep they're like good okay so i usually will have to get really specific how many hours do you sleep do you wake up and feel rested because they haven't slept or they have because they've passed out from alcohol but they don't wake up and feel rested they don't they've forgotten what normal is it's exactly true and so there's some education that has to happen there is no really and and the siwas and the cow score really has some very specific identifiers that they can't hide their blood pressure right you know do they have goose bumps are they tremoring are they sweating you know are they having dreams at night about using all of those kinds of things that they can minimize some of it but some of it you see it's visual right right and so you take away some of that some of that that part of it um yeah yep the subjective part the next level is the medical piece which means you need a doctor have they seen a doctor and has a doctor passed off that they are even fit for treatment right because there's times that a client will come in for residential treatment and they need detox they full-on go into a seizure or something like that has a doctor assess them um that's an important piece and and there are medications to help ease the discomfort and how trust is that medic are the medical professionals there's some residential treatment who offer um an md and a doctor but they don't live there they're not they're close they don't have a 24-hour nurse right so often if they need some of that they're going to need a higher level of care from detox or a hospital and often that doctor is doing four or five different treatment centers and so sometimes it does a little bit of a delay there too yeah that's true and that's it can be challenging and the other challenge for a residential treatment center is how do we pay for a doctor to be there 24 7. yeah and now here's something else to keep in mind is that residential treatment is not a medically managed level of care 3.5 is a clinical managed level of care it's right there on the line right because if you go up to 3.7 that's medically managed that means it does have to have a doctor it has to have a nurse 24 7. those facilities if they're at least jayco accredited right there's accrediting bodies that make sure that their their policies and procedures are effective um that they're required to have a plan for treating somebody that's that has a medical seizure or medical issue yeah um so you might want to know what's that plan right because it's a good question you know what do i do you have an rn during the day it's starting more and more to where facilities good facilities will have our ends during the day and if they're contracted with insurance companies they're requiring it they're requiring some sort of a an lpn in the night and rn during you know eight hours during the day so we're starting to see that become more and more of a thing right and so listeners that's that's that's one of those boxes to check is what is the medical like i guess availability in a treatment center that you're getting is it a contracted doctor is it is it a nurse on site is it a combination of both these are great i guess it's great information for people to start looking right now so that was the thing that kind of was interesting to me when i worked at the county it was very different we were outpatient our residential was was over you know the government right and so they had all this stuff when i got into the private market i didn't realize um amongst these shortcuts but just some of the things that were that were just not considered like the doctor on site the other thing i was kind of curious about is in order when they combined mental health and addiction and then put it into that medical model that means that even us as therapists need to report on on medical issues is this person sleeping through the nights the night watch as you're going through is this person restless you know and and so many things i noticed so many times that when they'd go in and do room checks they would just make sure that a body was there right and they weren't trained on how to look for that kind of stuff and so really a lot of stuff we were just again going off off the fly but the thing that bothered me was that we had to we had to chart more of the the bad than the good you know it's all in how you're right you write it i did you know it's it's it's a point where i'm thinking all right we've got to be careful with this because when this person is medically sound to go but mentally and emotionally not what do we do right because that's where the step down process comes you know and so i know the the research about the longer in residential the better you're going to do but is that really true because i think the sooner you can get them back in you know to society with their families within that system with some good help with good moderating maybe even like at a level what they call what php right where it's php stands for it's day treatment partial hospitalization is what it stands for but it's really day treatment same like a nine to five right so you're moving from residential which is 24 7 down to that php or into you know iop or gop intensive output general outpatient um i i just think there's so much variation there because really we're now looking at medical stuff and medically you know after a few weeks you know they could be detox they can start doing okay but emotionally mentally they're not they're not there right well and that's a great question too it's something that when i when i read the documentation that comes in for a client i often look and go why isn't the doctor or the nurse assessing for these medical pieces their appetite their um you know their sleep and how they're feeling and are they having dreams right somebody needs to be assessing for that and it ends up falling on the therapist who isn't that's not your that's not your field of your scope of practice right it's on the psych text just you know this the regular general staff who many don't have any education or training maybe new in recovery themselves in a lot of cases exactly they don't know what to look for and so it's an important piece because the insurance companies are looking at the medical piece right and that client is a person and if we're not addressing the medical side of the client effectively then we're really not doing our part yeah and then you can focus on the mental health here's the thing that i don't see happen very often is a client will come in they'll detox they'll get into that better space but then we can tell right up front that it's mental health it's really the thing that's driving the substance abuse and what we don't see is the treatment plan shifting we don't see it shift and show hey you know they're medically they're more stable now but now we're going to address the mental health that's really driving this and here's the elements yes and to your to your credit blue is yes we i'll go into a facility every day and say i don't want you to tell me how good the client is doing i'm sorry i don't want to see that in their notes because we're not going to get authorized if you tell me how good they're doing they're not here because they're doing good they're here because they're having some major issues that are life-threatening right it takes lives every day and so i need you to tell me how they're not functioning exactly i need you to tell me how we're going to get them to function i need you to give me some measures of how we'll know how do we know when they're at a place where they can step down right right and the facilities that are better at doing that um they get more days because they can they can gauge it and say look yeah they're more stable medically but now it's we're going to treat their ptsd right they're going to treat their trauma or we're going to treat their anxiety and depression right well it's a paradigm shift and it's very different for clinicians to start looking at it through those lenses because obviously from the moment they walk in there we want to we want to boost their their emotional stance so they know they can do this we want to you know praise them and all this kind of stuff and though it really is we don't want to keep chopping at the tree you know we want to start to let it heal but i think you can do that at the same time knowing that they're there for a reason too right and so i think part of that when when we get caught into into you know us being that clinicians being doctors and all this other stuff the hardest thing for me was when i had to do a call with a doctor an insurance company there was one time when i i had to make a call i can't remember what you call those so when the therapist calls the doctor peer-to-peer peer-to-peer medical doctor oh shelly there's not one time when i didn't sit on a peer-to-peer and i'm like if we discharge this person right now on you know new year's eve they will die and i remember this one client and i was like and i had i did i had so much to go over really good evidence yeah but it was no medical and so you know on paper he'd been there for you know all 65 70 days and they're like well medically he looks fine and every time they would let him go and it took me a while before i realized they're not looking for what i'm doing in my office they're looking for what's going on the rest of the time the you know the medications are they're working you know sleeping all the stuff that they can they can measure yeah they want that's exactly right as the insurance wants measures because everything that you tell them is subjective um you know their mental health that's subjective and and they're not so sure that somebody should be in treatment for in rtt treatment or residential treatment for just a mental health and i say just to mental health right because because that's severe they want to be you know if you're going to be in residential you better be suicidal you better not be able to function you can't shower you can't eat you can't yeah right but you're right they're looking at those measures are you taking vitals and do those vitals show right because there's assessments that they're still detoxing because their vitals are over 80 you know their pulse is over 80 and their vitals are elevated right things like that um but you can say look this person they can't they can't engage in a healthy relationship they can't they don't have a support network but those things the insurance doesn't give a lot of weight to well i think insurance because they've been medical for so long and it's it makes sense because it's easier to understand measurable assessments and outcomes yeah that's where they get stuck rather than understanding there's still issues with mental health where people shouldn't just be released all the time yeah i'll probably kick myself for saying this but to a certain degree i know that that the insurance companies to a certain degree are correct as well because what if we hold on to these guys for too long right and if you have the same quality of care in an outpatient program that you do on an inpatient program that they could function even better because then you've got even more data to do therapy and counseling with at the same time getting them back on their feet because the scary thing too is that i've seen that rotating door with clients that just keep coming back and keep coming back and i'm like thin you know this is just my own philosophy if we see if we see clients you know multiple times it's time to refer them somewhere else because we're not giving them obviously what they need they need something different and that's not a that's not a that's not a great thing for the bank account but on the same breath i'm like then you're not we're not doing the work we're missing something that maybe another program designed with a different kind of modality years in this industry there's a lot of people that become institutionalized they only feel safe when they're in that 24-hour care unless they're in residential they'll relapse and so it has to it's it's such a balance and a dance oh it is it reminds me of a client so early on i was working at a halfway house for women coming out of prison and i was meeting with these women and oh my gosh just it was such an honor to hear the stories and to be part of that story and and one lady she said to me she's like i get out in a couple of days and i don't know if i can do it i've been in prison so much of my life that i don't know that i can live outside and she would even come and see me after she was you know in her own apartment in her own place and she's like yeah i don't know if i can maintain this and she says the sad thing is my son's doing the very same thing he's following the very same path and so it's a valid question is you know we institutionalized people before you know a long time ago years ago and and the idea is that we're not going to do that anymore because it's not healthy for them and so it's this fine line of you know when are they ready to go out and face the world again and still be in treatment right but they have to go back out because a residential treatment facility or environment is super protected yeah right they they have 24 7 access to people that are helping them and monitoring them and it's all about recovery and it's protected and then i heard this said one time this guy you know he was put on the bus you know he's finished with his rtc treatment he was put on the bus and sent home and the bus dropped him off in front of a bar yeah yeah and he went in because he didn't know how to say no he didn't know how to not do that right and so yeah there's a it's a fine line as to you know should they be in rtc how long should they be there and if they've been there time after time after time i mean you ask the question do they need something else or you know where's their motivation or whether their capacity yeah you know have we started where they need to start or where they're at so there's lots of questions and i don't have all the answers yeah but but you know those issues exist and i think part of that too is you know the one thing i noticed the disconnection between our residential program and then like our outpatient is that we wanted the consistency in the relationships to stay the same and so our outpatient attempted to practice the same philosophy that we had at the residential but it's two separate entities and they couldn't do it because you don't have 24 7 care and so there's a time when they're going to be alone yet they've been promised that no you're going to get the same treatment down there at our outpatient that you will hear and it's impossible and to a certain degree we almost set them up to fail because we were saying you can count on us we're always going to be here that's not true there was yeah too much once yeah but that's the thing too right as you get into sober living and you get into outpatient and whatnot and i think that's where the real work begins i think the stabilization should happen in a detox and residential and personally i think they should be shorter and i think we should put more effort and more time and energy into those outpatient programs to help you know take the training wheels off before we shove them down the hill on the bike um talk a little bit about maybe just the difference in time because i wanted people that that maybe have a loved one that is facing maybe court and we know that court's gonna you know recommend treatment if you're in residential obviously that's 24 7 right if you when you leave residential you you get into this interesting pool you know php iop gop would you mind sharing like the requirements of time how many hours does it mean yeah cause i really think that would benefit a lot of people that don't know kind of what all that means the commitments they're gonna have to make yeah and and it's interesting because residential is 24 7. you're being monitored you're monitored while you're sleeping you're monitored everywhere you go but um and there's really not it's an interesting piece because we say at least in my industry we say you better have at least 30 hours of clinical during rtc and clinical meeting with the therapist is that a week after 30 hours a week a week okay and when they step down to php then it becomes and we usually recommend it used to be that they would do php seven days a week but what they were really doing is giving them rtc treatment and they were still living there and they never did get to go out and experience you know partial hospitalization your thoughts on that good or bad good and bad okay depends on the person right because somebody might need more treatment they might need more stabilization and somebody else might be ready to go but but which one which one is it and i'll tell you right now insurance companies have wised up to that pretty quick and they call it stratification and if they see that you're giving them you know 24 7 care at a php authorization they won't pay for it they'll ask those medical records and they won't pay they want them to be moving forward they insist that they be moving forward so they've just said we're not going to pay for that so they're they're monitoring that they're watching and we will often recommend to a facility please just you know even they can they can reside there the insurance company cannot tell them where they live but you have to let them leave you have free you have to let them experience life and then come back and say how about trying really hard triggers and cravings and come back through get a part-time job i mean you know some of them have never really held a job for more than a month at a time so go get a job and now let's talk about the struggles you're having and that is a great time to start that yeah and how many hours is php so php is typically 20 hours a week of clinical so five days a week four hours a day you know i've heard some that say you've got to be in six hours a day a more high intensity but generally speaking it's 20 hours a week five days a week and and we recommend don't do it on the weekend like let them go be with family let them go you know into the community and do their thing so that you're showing the insurance company yes we are helping them step down i like that transition yes it takes a lot more effort but the client would benefit immensely right well they can and and that's the tricky pieces are they going to go use again which relapse is part of recovery right so you know let's come back at it and try which means if they come back to the residential program you know having had haven't been high what's that going to do to the rest of the group and so typically what happens they get kicked out and it's like oh my gosh come on right come on yeah well and why do they have to step up they relapsed now they're coming back and that doesn't mean they you know they went all the way to rock bottom again yeah they they have some skills let's see if we can incorporate those skills and keep them at php and if they can't maintain sobriety then we look at stepping them up right i think sometimes we do it too quickly yeah but there is safety factors there and can we express those safety factors to the insurance company and then to the question and then after php you know they're there for a time maybe that's 20 days maybe it's 30 days maybe it's longer and they start to acclimate and get good at some of the life skills they have to incorporate then they can step down to iop which i've seen some transition and i kind of like this transition they'll you know for three or four weeks they'll do iop at five days a week three hours a day the minimum is nine hours a week so for intensive outpatient iop nine hours a week nine hours a week clinical with a licensed therapist or counselor face-to-face clinical yeah group but with a master's level or sudsy or you know someone with some credentials nine hours is the minimum typical iop is three days a week right you're coming three days a week you know maybe three nights a week three hours at a time and you're you're getting a job right you're now starting a full-time job or you've gone back to be full-time mom and you're just coming in to kind of you know continue your recovery continue practicing these skills because it's like um i like to use the analogy of a rocket right a rocket going to the moon takes i'm throwing out this randomly 90 of its energy 90 of its power just to get it off the ground and out of the atmosphere changing our patterns and behaviors is like that it takes so much and then after we've worked and we've worked and we've worked we can finally see the fruits of all of that effort right and so change is hard we need to continue in treatment and you know and then once they've done iop you know and they get to where they're you know three hours three three days a week three hours a time and that's you know they're doing really well then they can step down to general outpatient or routine outpatient which is you know i'm going to maybe do an individual therapy maybe once a week i'm going to come to group once or twice a week you know i'm stepping down i'm stepping back and then you know i would think you would want to see their involvement in some sort of a social um a socially sponsored group of some kind it doesn't necessarily have to be addiction or aaa or something like that you know you know spirituality and going to church and having some other connection with other individuals yeah i used to tell people when i was in private practice i'm like you need a support network go find a church i don't even care what church it is but there's good people there that will help you go find some sort of a support network i absolutely agree you need somebody you and this is the piece this is where healing really happens is when somebody is seen and heard and understood right you know and when you can really get into that person and understand what's going on and reflect that back to them then their whole body just relaxes and they can go oh yeah somebody finally gets it they feel safe enough to yeah and it requires another person to do that at least one if not a whole multitude of them right absolutely right well and that brings up an issue that i've noticed in quite a few private programs and that's the lack of family and and support system interactions you know there's just no time and i'm like i i haven't i don't know of a program that that weighs heavily on family involvement maybe they get a call maybe they do get to do a session or two but there's not a lot of interaction with them and you know we tried many times to get things launched and whatnot and it would be minimally you know like attended and it would dissolve and die and i don't i need to be a lot more effort on that too but again how does it fit into those hours and is that the greatest bang for your buck because all that stuff takes a lot of energy and a lot of time right um how important is it for family members to know what they can and can't do what they should be asking for and you know because eventually hopefully the goal is to get that loved one back into that family system so be it healthy and safe well that's that's a tough question because in some situations the family's just not safe they shouldn't be you know they shouldn't be engaging with the family but by and large they usually have a family that loves them and that family has an interesting dynamic that's often dysfunctional right often not always but often dysfunctional if the family is not in some sort of treatment and is not being exposed to what is addiction what are the patterns of addiction what do i need to know about that how do i love somebody but hold boundaries with somebody that's in their addiction yeah how do i communicate my feelings and what should this look like if you don't have that engagement then they're going to go back into that family and they're going to take on they're going to do right that client's going to do all of the treatment and all of the healing and they're going to go back to a family unit where they're looked at the very same way they did before they went to treatment yeah and they did huge leaps and bounds about oh yeah yeah you know i've always but now they have all these opinions and these thoughts and they want to share always compared it to like being in a play a family has a certain cast they have they have certain you know parts that they share and they talk and when so-and-so says this i say this and so then that person in recovery leaves and they get a whole new set of words they get a whole whole new actions to speak out and then they're put back in the exact same play doing a different part yeah and everyone's like what is going on here how does this work you don't say that when she says this you have a part to play and you're not playing that part i love the way you say that and it's exactly right it throws everything off if the family is not part of that dynamic um you know i've seen adolescents go to treatment and if the families are not part of it that adolescent is not going to go back home and get better exactly they're not because the family dynamic is part of the problem right um but families don't want it right what they're doing and and here's the sad thing is that you know someone in their addiction is really burning bridges right and they've really used and abused those relationships and the family's happy to have them gone a lot and so that creates this dynamic that person knows that and how do you bridge that gap how do you heal it do i think it's important i think it's vital if the family i mean that's you know that's yours you're solid that's the piece that never will change but if you can't utilize the family you've got to have somebody yeah okay i have a really hard question i hope you can you can help me understand this let's shift gears into uh maybe an individual who starts out in residential that needs or has been prescribed m-a-t medicated assisted therapy um many times i've seen them get started on on matu but then once they run the gamut all of a sudden they realize oh my insurance doesn't cover this or these problems now i need to be taking this medication but on this side of treatment i can't afford them what have you seen and what i guess you know do you know about which direction these families these people should go in trying to figure out medication-based treatment where they're going to need it but maybe their insurances and whatnot don't cover i mean how do they do we set them up for failure if we put them on things that that we know they're not going to be able to take outside of there but because it's easy and convenient right now i mean there's a lot of care that needs to be taken on that path yeah and and that's a big one because there's a lot of evidence that says medication management i mean even in the addiction world right there's some stigma against being medication man against doing it because if you're on a medication you're not sober yeah we've heard that one before we don't agree with that no we don't agree with that because that's the same way as saying somebody who's depressed clinically depressed shouldn't be on a medication and that is not true right absolutely no one would question that no one would question a diabetic taking insulin right you wouldn't even think twice about it or you know getting the common cold or the flu yeah you're going to take a few days you're going to take some cold medicine you know you're going to make yourself feel comfortable what's the same thing there you know there are things that you can take that have been trust tested and tried and true that help people stay sober right they help the cravings they help all sorts of things in in that avenue they help you know that if you do end up relapsing it doesn't have the same effect it won't kill you and so those medications can be vital you know you've got to work with your doctor as to whether those are maintenance doses to where they go on for years and years and years and maybe your whole life right some people don't need that and they do or whether it's short term those are questions you've got to talk to the doctor about but i think it's an injustice to not use medication management to your question um to my understanding those clients unless the facility is somehow paying for that medication which i don't think is very common yeah i don't think is um is talked about yeah but i think is unethical um maybe for some of the same reasons but you know just like you can't pay for someone's premium yeah um it might be vital that they have those medications and the facilities pay for those um but yeah then it then what do they do when they get out exactly you know and so you've got to like say vivitrol which is a great medication it's being used a lot you can do it once a month and it's a shot so that that person can't abuse it you know they can't decide not to take it one day fantastic medication and incredibly expensive exactly incredibly expensive blows my mind you know i would hope that one day we'll get a generic and it'll be more affordable yes um a lot of these i don't know if you've seen it but i have started to see a lot of grant programs coming down because of the opioid epidemic that there are a lot of facilities now being able to lessen the price or you know do a lot with the grant money for you know vivitrol and some other types of medicare good questions but you yeah you've got to call around and ask but i think every day there's probably more of them and i hope that that bulb really really starts rolling yeah that's good to know but yeah but if they leave and they don't have the means and they run out at day 30 then what right what do they do and who's there to help them who's there to advocate for them then and that's why it's important to stay in treatment and and maybe find some solutions right and i love the idea that i hadn't heard that that there's grants out there for it and and for good reason yeah good reason um i know that i've also seen facilities that will buy vivitrol specifically in bulk and then they will administer those shots for the clients um and that i would think that under those situations it might be a little bit cheaper so facilities you know any facilities that are listening could maybe consider that as an option right yeah right so one thing we've noticed too is because mat still seems to be kind of like the new day of dawn um i've seen treatment centers that don't understand it or maybe don't agree with it that then rapidly you know taper them and they're like they're always shooting for that abstinence-based lifestyle and we've learned through sad experience that that's not always the best practice um are you seeing more treatment centers or more insurance companies kind of wanting you know maybe or did some change to like say hey let's work with what this client needs instead of like what you want you know with your own philosophy yeah um absolutely insurance companies are not only encouraging mat but if a program is not engaged in m t you rarely see them get contracted with that insurance company right you know they may not come out and tell you that but some of the criteria is that you're that you have the options of doing m a t and it is part of your program i will say that the stigma that is there about taking that medication is is there i think it's probably a money piece more than anything because i do see some facilities engage in it and i talk to a lot of facilities about they want to know that this client is seeing the doctor every week right that doctor is doing something for those clients right they if there is medication that can help them to maintain sobriety then they need to be having that conversation and it needs to be documented is the client denying it are you educating that client on the benefits of that medication are you helping them understand how this can help them stay sober and isn't that the goal so that they can continue to function and continue in their values and and quality of life absolutely um i don't see it being implemented as much as i would like to see it right well and i've seen it a lot in residential and then quick taper out or they say no you can do it out but then they go to sober living or halfway houses and no one will let them have it yeah and i'm like this is the time that their cravings and triggers are really kicking in the time that they really need it i remember we had a client who was on a pretty high dose in residential of um suboxone and had tapered down but was still on the lower dose went to outpatient and then wanted his dose up and we were like is he trying to just get high again but now years later i'm recognizing no he was having tons of triggers and cravings he's living life and frustration and stress and that make perfect sense hopefully he was working you know working with the doctor as to why he wanted his suboxone raised them you know because that's a great time that that may be necessary yeah and i think something that gets missed a little bit is so in a residential treatment you've got a medical provider right there that sees the clients yeah i think it's a mistake to not transition that person to a private practice person to a to a what do they call a primary care physician their own physician i agree yes that they are creating a relationship with that knows them long term that's going to be with them long term and they can help them navigate this medication is really expensive let's try something else and somebody that specializes in in addiction medicine right that would be important and so are we doing that or are we keeping them with our medical provider and how are we helping them because again that's a life skill that they've never probably been able been exposed to right and they won't be able to stay with the facilities medical provider forever right you know because they don't typically see people on an outpatient basis right they're only seeing people in the treatment center um and so yeah i don't and and i granted it's not something you write a note about so maybe it's happening more than i'm seeing but i think there's a gap there well i've seen it firsthand and it's always that way and then there's there's that you know understanding that that if you move to outpatient you can't see the residential doctor but then where do they go right i mean so it's like there's got to be more consistency to have a good one yeah yeah yeah the medical model is an interesting one and it's something that i think caught a lot of us off guard because we were so used to that traditional you know talk therapy and just you know you know absence based and if you mess up your outing here kind of stuff um are you seeing some some push back from the industry versus some acceptance that this is the way it's gonna have to be or do you feel like no it's pretty homeostatic it's it's you know one in the same no it's being pushed all the time i often will use the example of the medical field now you've seen the medical field make a huge transition to where um i'll use this example my daughter-in-law went in for heart surgery open-heart surgery and there was a glass window and a booth a computer booth right outside her her door or her her room and that nurse sat there and watched her and recorded all of the things that were going on with her the entire time why did that nurse do that oh so they could get paid yeah right so the insurance companies i've seen that yes when maurice had to go to the hospital last month they had a little car that pushed him with her and all that girl's job was typing everything that was being said and being done take assessments you're going to take sometimes i come and do vitals they'll do an echocardiogram right you are documenting everything that you're doing to prove that that person needs the care that you're providing insurance companies are really smart they've already done this before we are moving towards that and it won't be a total medical model because mental health is not medical right right but there are medical aspects to it and and it's you know really to do a good job we've got to move into that space and understand the whole person right it's all of those pieces so you see that frequently because again one of your major aspects of the job is to read charting to look at those medical things to advocate for payment through insurance i mean you have i think the world's hardest job people don't realize how difficult that could be i can only imagine um documentation is one of the things that every therapist counselor everybody hates but it is the absolute most critical aspect of that whole experience is to if it's not if it hasn't been written it never happened even if you had the most amazing breakthrough correct like it doesn't matter unless you write it down yeah well it doesn't matter to the insurance because they're just looking at what are you doing have you documented it and the interesting thing is is when i went through school and and blue you tell me when you went through school and they teach you how to do notes did they sit down and say these are the things that should be in your notes and if they did it might have been one hour class yeah it was a it was a brief discussion about soap notes soap notes yeah right and it's like what's a soap note and why am i writing it yeah um well because we were handwriting everything we tried to really minimize it all right and here's what i'll tell you is you don't have to write a lot but you do need to write the most the important pieces like this client cannot sit still they cannot sit in therapy and manage their anxiety around any topic that brings up emotion right and so that's pretty simple you know we touched on this topic client was reactive client started you know walking around the room and pacing and was shaking and right that's it yeah you don't even have to write what you were talking about but you do have to write the reaction of that client so that you can show they're not stable right they might be you know going in and talking with all of the other clients and they seem happy and all the staff is writing yeah client did really great but the truth is they're not or they're coming to therapy and they really are scared and you can tell they're scared i mean things like that you're you're talking about the symptomology that you see and the behaviors that they have right and most people are never taught most therapists are never taught how to document like that absolutely absolutely i have a question a lot of you know paid clients patients or family they pay the premiums to the insurance company how much clout how much here say how much do they have to be able to contact the insurance company themselves a lot of them they don't know what it is so they just leave it up to the facility but i know that there's probably some things that they can do they call in and say i'm paying you what are their rights with some of that that's a great question and and it's a fine line yeah we've kind of you know if you've got a client going into rtc treatment it's not a good idea for them to call their insurance company and advocate for themselves because if they can do that they probably don't need residential treatment there you go good point right because the insurance company has now got this client on the phone and they're functional just like clients that think they can go to residential care and they try to detox and table at home yeah you know they want you sick sadly it's so true yeah they tapered they detoxed at home and now they're coming to treatment and they're like yeah but they've already detoxed they've been sober for five days they can do that at home now they don't need residents oh man catch 22. it is so so it's it's kind of tricky but um oh shoot what was the question well even just asking for maybe more care can they call the insurance company and say i know i'm unsafe or can a family member who's on the policy typically will have family members it's not a bad idea to have family members call it's it's a different scenario and some insurance companies will really listen and some insurance companies it doesn't really matter but when you can talk to the member side we always have to talk to the provider side of an insurance company when a member calls they talk to the members side and those you know they value their members they want to keep their members and so they certainly have advocates for them they have people that will help them it doesn't always help the cause but it it sure can and i've seen it turn it around on on some in some cases so um so yes i think it's a good idea for them to advocate but then again do they know what they're asking for yeah do they know what language to use and are they going to make it better or worse right right so it's in and of itself it's kind of a i don't know an obstacle course trying to make it through without getting too damaged because if you say the right thing there you go see the wrong thing you could be down in a hole that you'll never get out of because they don't forget they record every call just so you know yeah absolutely well it makes sense i mean they're in the business to try and keep money not give it away right so i think that's important too then because you know you're telling me that there's programs out there that could charge upwards of sixty thousand dollars yeah you know with insurance or without insurance i've seen that before when people walk through the door and the first thing they're like hey yeah we can help you get the right insurance but now you know let's divvy out that six grand to get you through the door yeah people just don't have it well they don't and and here's the great thing about that and and that program that was 60 000. that was cash pay those people are coming in with cash they're not using they don't need insurance they don't yeah so i can't even imagine yeah that's not my world um but people that um that have deductibles and co-insurances most insurances have that right that's the patient's portion that they need to be contributing there are situations where a facility can do a hardship letter and they can show that that person has no finances they can't possibly cover that the family can't cover that so we're not going to collect it and insurance companies will actually honor that as long as it's not every client that comes through the door right um so there are some things and i've seen insurance language come out that says yes you can do you know you can you can waive that i mean that's money to the facility um but there are situations where that can happen and so knowing that that's an option because how many people that have been active in their addiction for a long long time i think of the lady that was you know lived down on the jordan river for seven years she doesn't have any money she has zero money but she can get maybe medicaid or maybe she can get on some you know some of the marketplace plans now thank goodness for you know for some of that yeah well we we got we were in in the industry when uh when a company um was giving out lots of treatment and they had to roll back and it was interesting because i think it also exposed some over some overdoing it you know everyone all of a sudden that had this plan had treatment and it pretty much but i don't bankrupt that insurance company but it got close because everyone had this insurance and they paid pretty well so i'm thinking there's wherever there's money there's also the potential for abuse and so we've got to teach these clients these families to do their research right um sadly googling things aren't it's not where it's at anymore you know you know with uh within with programs paying you know like they're for iso to get their you know their their websites up there and for this new legit script thing that's supposed to be the gatekeeper it's all about money um you've got to do boots on the ground you've got to go check these things out and ask some of the hard questions does my does my loved one have access to their chart can they see their treatment plan how often is it reviewed you know like all these things right it's it's a steep learning curve well it is and i think it's interesting because that we know that the best treatment is engaging the client right what is the client's goals if you're writing a treatment plan and that client didn't have anything to do with that how is that helping exactly how are they even going to know what their goals are for treatment if they're not part of that process and i know it's harder because they may not know the answers but to be able to dig deep and and sit with them and where are you and where do you want to be and what does that look like because it's pretty clear a treatment plan that's written by a therapist and a treatment plan that's written with a client yes night and day difference and it makes a huge difference on their full outcome you know a lot of facilities i think they have in their mind how they want clients to leave and many are that 100 abstinent based they have a job they have but maybe that's not what the client really wants maybe happiness for them really is you know on mat they're doing harm reduction that they just get a part-time job and live at mom and dad's house and that's okay for them you need to find out what do they want meet them where they're at and go from there instead of what you think the ideal perfect well that's a pretty utopian idea though i know you know i mean that's because again every program has their own niche and their own you know like like i guess term for success right yeah but it should be it should be client centered absolutely but there's there's there's so much more meat on that bone you know i mean i i hear what you're saying but i think as we're as we're getting close to the time here i'm i just think that they need to do more research you know and how do they do research what would you recommend for someone who just had a husband roll into the house and and like i need help where do they even start that's a great question i know that in utah anyway utah has this fantastic two one one resource that you can call and they have just a myriad of resources they can get you connected but if you don't have that resource call your insurance company yeah and they they have people that advocate and can help you kind of navigate where is it going to cost you the least amount of money you know who are we working with who do we know that's you know because the insurance companies know who's good and who's not right or at least place they they monitor that other resources go to your primary care doctor say look we need some help who do you know how can you know where should we go from here there are resources you just have to start reaching out and you may have to reach out four five six seven eight times before you find someone that can really give you some good information and then it depends do you have insurance don't you have insurance do you need to see a broker to get some insurance first to help pay for that treatment and is that even an option and you know there's tons of questions there and so getting someone that can help you and advocate for you is really important um and maybe it's find a therapist that can help walk you through that right that process right somebody that can advocate for you yeah yeah i know we get lots of calls through addict to athlete and you know we we advocate for those things too because we know of many treatment centers that are fantastic but we always say go check them all out i'm not going to give a stamp of approval to any one of them you go look at all four of these and you pick what's best for you get a list from your insurance where it's covered and then you go ask some of these other questions there get you know if you can visit the facility because you get a different feel than somebody you know that's a car salesman on the phone trying to sell you their treatment center and they're very very different isn't that the truth yeah and the most important thing i'll come right back to this is that you can create rapport with somebody yeah if you go into a treatment center and you can't connect with anybody there walk away right absolutely you know what's the aaa say come at least six times yeah to see if this is a good fit and if it's not then let's find you a place that is right you got to give it a try but at the same time you've got to be able to create rapport and be able to ask for your needs and you know the last thing a facility wants to do is have you say look this isn't working out for me once they've got you in there so that becomes you know again you need an advocate yeah and that's why yeah you have to do what's best for you or your loved one not not the facility right and facilities i mean facilities the the really reputable facilities out there they want what's best for you yeah and so you'll you'll hear a different approach they may not like it but they're like we understand and we want to keep you in treatment so let's find a place that works for you absolutely i think that's i think that is exactly where the starting point should be we had a friend who uh anonymously was calling up a couple of programs that weren't so hot and it was interesting because all he wanted to know is who led the groups and what's their credentials what are they are they are they substance use counselors are they you know master's level therapists and it was crazy because all the guy kept saying is well what's your insurance what's your insurance he just wanted the insurance yeah so you'll you'll tell pretty quick if you get that used car feeling but you know sadly there's a couple of programs that have that have you know kind of tainted a lot of the other good ones and so do your research because there's a lot of good programs we're very lucky in utah we have a large variety of programs to choose from and so we're real lucky but for you know do your research you know don't just and i'm grateful this year the you know healthcare.gov the marketplace is open until march or may 15th it used to only be open november 15th to december 15th so if you're hearing this before you know the end of may 2021 yeah you can get on to healthcare.gov you can call or find an insurance agent that can help you get a marketplace plan and if it's today march 9th your insurance would kick in april 1st if you do it before the 15th of the month your insurance starts at the first of the next month you can find and start looking at facilities and when you call that insurance and you're looking at plans find it plan that has substance abuse or mental health coverage there are plans out there that don't exactly and so if that's what you're looking for you need to get yourself a client that does have that well i'll put one more plug in since the expansion of medicaid if you don't have any income you will qualify for medicaid and medicaid is now covering substance abuse treatment and so you know even if that's what you have you can get treatment there are lots of facilities that accept medicaid now yeah and we know a a couple of great doctors that that are specializing in addiction that take medicaid and so community doctors and clinics yeah so the help is out there just just don't be worried to ask for help that's one of the biggest things if you if you're feeling stuck reach out you know through through marissa or myself on team edit to athlete your physician you know shoot call and and we'll help maybe guide you where you need to go and i can do those substance abuse assessments for court or if you're just looking for treatment and then i can give you the recommendations and you can go choose what fits you absolutely shelly thank you so much for spending some time with us today it's been great and this is going to be one of those ones that we'll have to bring you back on because i'm sure this will spark a lot of questions that the athletes and families will have yeah well this has been a lot of fun and i'm pretty passionate about substance abuse it was never my dream to be in substance abuse but it calls to us doesn't it it truly does and and you know just even from a personal standpoint um great working with you and the billing company you guys made it so easy and you answer so many questions and so i just want to appreciate and thank you for all the work that you've done you've helped us a lot i remember talking to you about situations you're like well have you thought about this or that like aha so it's kind of neat to have an advocate on that side of uh you know of the whole industry so thank you so much for spending the time athletes you've been well fed um share this podcast with anyone who needs help in this direction i mean this will be a good resource for you to have kind of maybe download it on your phone so you can you know pass that on because it's uh there are questions that need to be answered and i want to give a special shout out thanks to all of our patreon subscribers and of course let's give them all a shout out because they deserve it we've got our super fans jerem thurston holly davy scott foster coach chris williams brett fruit chelsea olsen antonio dominic and of course the warrior within podcasts and personal development with sensei kp thank you so much super fans rookie level subscribers josh hanson kenny roseman earl dyer and joe jackson thank you rookies for all that you do for team addict to athlete our two parole level subscribers of course selena armitage and gary thurston you guys are absolutely rock stars and pro and also our championship level subscribers thank you so much this is the top tier you can get on patreon and we have shad and freya robinson and the robison family and ron and delosh thank you guys so much for being willing to support team addict to athlete as we strive to make this not just our career but also to raise awareness to help more people to get this message further to provide content that's going to help people overcome addictions and of course mental health issues so thank you so much if you'd like to become a patreon subscriber you can do so as little as two dollars a month to get all of our bonus episodes and other perks and features and merchandise as as you go up the the scale of tears so again you can grab that on addict to athlete's webpage or patreon.com forward slash addict to athlete thank you guys so much for all that you do for team addict athlete and specifically radio ronin and the radio ronan tons of podcasts that radio ronin has there's some good ones there about self-help some comedy and even some music podcasts so thank you radio ronin and athletes until next time go turn that mess into a message you