An Online Resource Center for Family and Friends of People Battling Drug Addiction

Insurance and Healthcare Information

How is it possible that as the carrier of the family insurance, my daughter overdosed and was treated for drug abuse on more than one occasion and I wasn’t even aware? Shouldn’t I have some access to information if I pay the bills? – Madison Parent

Insurance and what a health insurance plan covers affect many decisions concerning access to services and treatment.  As you seek help for your child or loved one, one of the first things to know is — What will insurance cover?    What are the eligibility requirements for different types of treatment?  Can you/how can you access your child’s health information?

Healthcare Insurance Information (pdf).  The Parent Addiction Network surveyed the healthcare insurance providers in Dane County in late 2012.  See the document for information about each one, what to do if you don’t have insurance, tips and questions to ask your healthcare provider when you are seeking information about drug treatment services.

 **  11/1/2015   Many Dane County residents have not yet signed up for health insurance coverage through the Affordable Care Act even though they are eligible.  They have another chance with the start of open enrollment November 1, 2015 – January 31, 2016. Get free help to sign up for Marketplace insurance or BadgerCare Plus in Dane County plus help to pay your premiums through United Way HealthConnect, call 2-1-1 anytime, day or night.

– See attached flyers for key information and list of local resources and help:   Five Things to Know about 2016 ACA Health insurance. Most people get financial assistance to lower their costs when they sign up through the Marketplace, and Dane County residents may be eligible for additional financial assistance through the United Way HealthConnect Program – call 2-1-1 or see their web pages: Click here for English;  Click here for Spanish

Affordable Care Act and Health Insurance Marketplace Information.    The ACA designates addiction treatment as an “essential health benefit” so most commercial insurance plans must cover it.  Read more…

     See the “Consumer Guide to Health Care – Paying for Health Care in Wisconsin website for complete information.

The Health Insurance Marketplace Call Center is:  1-800-318-2596 1-800-318-2596 (TTY: 1-855-889-4325 1-855-889-4325)

The Dane County Job Center is another good place for information:   608-242-4900 608-242-4900; www.danejobs.com

The Office of the Commissioner of Insurance includes updated information on health care reform.

If you are looking for insurance for yourself or a loved one, try contacting Employment Resources Inc. of Madison. There are many ways to get people insured and ERI can help explain the options.
4126 Lien Rd #104, Madison; 608-246-3444

What do I do if we don’t have insurance?

Contact Journey Mental Health

Journey Mental Health Services
625 West Washington Avenue, Madison
Telephone: 608- 280-2720 608- 280-2720 24 hours Crisis Services for AFTER HOURS EMERGENCIES ONLY: 608-280-2600 608-280-2600 
www.journeymhc.org

For AODA services: Walk-in registration for same day assessment is available on a first-come basis on Tuesday-Friday at 8:00 a.m.
For mental health services; Walk-in registration for same day assessment is available on a first-come basis on Tuesdays at 8:00 a.m.

AADAIP (Adolescent Alcohol/Drug Assessment Intervention Program) is a UW Hospital and Clinic program that provides affordable assessment and referral service.
PH:  608-262-1111 608-262-1111

Various treatment services include a self-pay or sliding scale option.  See the Drug Treatment Directory, Dane County (pdf) for a listing.

TIPS

  • Try to get your child/loved one to sign an authorization for release of information.
  • Read over the policy and understand what the policy says to make your conversation with the health insurer more productive. Ask for clarification on anything you don’t understand.
  • If you have access to the insured’s health care card, have it in front of you when you call.
  • Keep records of phone conversations. Document the time and day and the person you spoke to.
  • Remember – Be a knowledgeable advocate for yourself and your child. You have the right to know and to understand!

QUESTIONS TO ASK THE HEALTHCARE INSURANCE PROVIDER

Service Provider Information

  • How do we find a treatment provider?
  • Can the insured person choose the treatment provider?

Treatment Coverage

  • Do the insured’s benefits cover inpatient treatment? If so, what kind, where and what is the maximum stay per visit, per year. For example, do the benefits provide for 14 days, 30 days or 90 days per stay?
  • What if the patient left an inpatient treatment program before completing the program, will the patient’s benefits cover re-entry for that or another program?
  • Do the insured’s benefits cover outpatient AODA treatment? If so, what kind, where and is there a maximum treatment period, per year?
  • Do the insured’s benefits cover co-occurring AODA and other mental health conditions? Do the benefits cover only certain co-occurring mental health conditions?
  • Are there co-pay requirements for inpatient or outpatient treatment programs?
  • Are there co-pay requirements for medications like suboxone?

Authorization

  • Does the patient need a prior authorization/referral from a primary physician before your insurance will cover Alcohol and Other Drug (AODA) treatment and/or therapy?
  • Remember- Things will go a lot more smoothly if you have a prior authorization/referral from your child.

Therapy Information

  • What kind of therapy is available under the insured’s benefits? Is drug therapy (treatment that involves using medications to treat a disease or condition) available?
  • Can I, as the parent, access therapy for me and/or for my spouse and family members? Do I need a prior authorization from my primary physician to access these services?
  • Do you have rules and regulations regarding therapy services?

Rules and regulations regarding treatment

  • Do you have rules and regulations regarding substance abuse treatment services?

NETWORK NEWS

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GET INVOLVED

We host this website, we are an email distribution list and we are a group that meets monthly to network and work for change.

If you would like to be on our email distribution list and/or get involved in our activities, please contact Amanda, at Safe Communities, 608-441-3060, 608-441-3060 or e-mail: info@safercommunity.net.

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