Benefit determination under managed care for substance abuse treatment clients.
Care Manag J
; 3(2): 55-62, 2001.
Article
in En
| MEDLINE
| ID: mdl-12455215
ABSTRACT
The purposes of this study were to examine the process of benefit determination, approval, and variation among Substance Abuse Treatment (SAT) clients. A convenience sample of 20 SAT clients admitted to 1 of 2 treatment programs within Matrix Center were followed. Clients of clinicians who agreed to participate were given an invitation letter to hear more about the study. After informed consent, clients granted 3 interviews and gave permission for the researcher to examine client records to ascertain the benefit determination process. Referral sources were the clients' insurances, their MDs, a counselor, hospital, Employee Assistance Program, case manager, and another treatment program. Ten of the insurances were PPOs, 9 were HMOs, and 1 was a contract. All but 2 had benefits managed by a behavioral care organization (MBCO). Case managers of the MBCOs were all clinicians, most frequently ACSWs. All programs authorized outpatient care and the first approval authorized from 6 to 52 visits. From 1 to 5 different authorizations were used for each client. The co-pay ranged from $0 to $35 per visit. This study illustrates the details of how benefits for substance abuse treatment under managed care are negotiated and used.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Managed Care Programs
/
Substance Abuse Treatment Centers
/
Insurance Coverage
/
Substance-Related Disorders
/
Eligibility Determination
Limits:
Adolescent
/
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Care Manag J
Journal subject:
ENFERMAGEM
/
SERVICOS DE SAUDE
Year:
2001
Document type:
Article
Affiliation country:
United States