Once you've agreed that you have a need for a rehabilitation program, it's time to locate an appropriate and effective program that can work for you. There are many ways to choose a rehabilitation program.One is to pick up the telephone directory and search for rehabilitation centers. It's a start, though it may not be effective. There will be several rehab centers listed, all claiming 100% efficiency and a high recovery rate.
The best method is to get recommendations from others who have experienced treatment from a particular program, or know someone who has been successful. For this to work, you or your family members need to be candid about the problem when approaching other people.
Alcoholism Treatment Program Referrals
One good resource is your church minister. Your minister will consider your conversation confidential, and his advice and information is usually accurate. Being at the hub of the local community, a minister will have access to information from community leaders that won't be available to the general public.
Another good source is your family physician. Your doctor may be able to provide you with first-hand rehab program information and locations. Even if she does not have the information, she should be able to direct you to the right people, resources, hospitals or recovery centers.
A third source can be your local hospital. Most hospitals offer some form of recovery support, though the extent of the program and the intended medical condition that it addresses varies. Alcoholism today is a fairly widespread issue in our society. Most hospitals offer some sort of program or a counseling center that will provide you with more information and resources to follow.
Other sources include online support groups:
- Alcoholics Anonymous
- National Institute on Alcohol Abuse and Alcoholism
- The Addiction Resource Guide
Are Alcoholism Treatment Consultants Truly Helpful?
Most private institutes offer some form of "consultancy" that first gathers data about your problem and then recommends appropriate courses of action. Generally, the consultancy offered by any institute tends to promote the programs they offer.
Avoid those claiming to be consultants since they typically operate on a commission basis for an institution and aren't objective in their recommendations. Exceptions include those working for a support group like Alcoholics Anonymous, in which case their credibility is higher.
How to Fund Your Treatment Programs
Most individuals pay program costs. If you lack the means to do so, there is some help available, but needs to be researched. Public health offices offer lists of funded programs. These agencies have strict ethnic or economical criteria you must meet in order to be eligible for funding.
Other sources include the local church and Non-governmental organizations [NGOs] working with poor and marginalized people. NGOs also have strict guidelines for those seeking funds for therapeutic purposes.
A third and most popular resource is the individual's family network of relations, friends and supporters.
Access Card/Fee-For-Service Service Programs
If you're enrolled in an Access Card/Fee-For-Service program, you can often access drug and alcohol treatment by calling yous state health department. For example, if you live in PA, you can callthe Pennsylvania Department of Health Single County Authority (Drug and Alcohol Program) in your county. You will either be scheduled for an assessment, or be referred to two drug and alcohol programs to call for an assessment. Click here to find contact information for the Single County Authority in your county.
Drug and alcohol treatments available through MA Fee-For-Service include:
- Hospital Detoxification
- Hospital Rehabilitation
- Methadone Maintenance
There are limits to the amount of drug and alcohol treatment services you may be able to receive. These will depend on your category of Medical Assistance eligibility. Children are always entitled to any treatment that is medically necessary.
If Medical Assistance denies treatment, reduces your services, or terminates services you are receiving you can appeal the action by requesting a fair hearing with DPW. You are entitled to a decision in writing if MA denies, reduces or stops services. That decision must tell you how to file an appeal.
EDITOR'S NOTE: You can contact your local county health office in your state for similar programs that they offer.
Accessing Drug and Alcohol Treatment Programs for Medicare Recipients
Recipients can access drug and alcohol treatments through their Medicare coverage. Part A covers some drug and alcohol treatment received in a hospital, including room, meals, nursing and other services. Part B covers some services provided by drug and alcohol professionals (inpatient or outpatient), outpatient therapies, lab tests and partial hospitalizations. The Medicare program does not cover a certain "package" or defined amount of specific services. Rather, it covers a portion of the cost of health care, including drug and alcohol services, which are reasonable and medically necessary according to Medicare's written standards.
To access drug and alcohol services through Medicare, ask your doctor or call 1-800-MEDICARE to check if Medicare will cover the treatment or service you need. Medicare does not pre-authorize treatment or services and will not advise you before evaluation whether a treatment or service will be covered in your situation.
Medicare does not cover the total cost of most treatment and services, so recipients are normally required to pay deductibles and co-payments. If you have Medical Assistance (MA) and Medicare, your MA can be used to cover co-pays and deductibles. If you have MA and Medicare your providers must accept that coverage as full payment and cannot bill you for any balance on covered services.
If Medicare denies you any service you have appeal rights. See your "Medicare & You" handbook for details on appeals. See 'What Medicare Covers' for more information on accessing drug and alcohol services through Medicare.
Accessing Drug and Alcohol Treatment Program Private Health Insurance
Whether or not your private health insurance covers drug and alcohol treatment depends on whether the plan is an ERISA or non-ERISA plan. The Employee Retirement and Income Security Act is a federal law that sets standards for certain health plans offered by employers. If you get insurance through your employer, call and ask your employer's benefits manager if the plan is an ERISA or non-ERISA plan.
ERISA plans may, but are not required to cover drug and alcohol treatment. Non-ERISA plans and other group health plans are required to cover at least the following drug and alcohol services:
- At least 4 lifetime inpatient detoxification admissions (up to 7 days each)
- At least 30 days per year (90 days lifetime) of non-hospital residential treatment
- At least 30 days per year of outpatient or partial hospitalization services
Read your private insurance member handbook or your insurance contract to confirm what is covered for you and to see how to access services. Those materials will also contain information about appealing a denial of services.
Accessing Drug and Alcohol Treatment for the Uninsured
If you have no health insurance, you may still be able to get drug and alcohol services. There are two options. The first is to explore your eligibility for Medical Assistance. The second is to contact the Pennsylvania Department of Health Single County Authority (Drug and Alcohol Program) in your county.
Qualifying for Alcoholism Assistance Treatment Medical Assistance
Persons undergoing active treatment for drug or alcohol addiction may be eligible for full Medical Assistance if participation in the treatment program precludes employment, and the program is licensed and approved by the Department of Health or is administered by an agency of the federal government. The applicant must also meet the citizenship, residency, income (income limits vary by county, ranging from $174-$215/month for an individual), and resource ($250 for an individual; $1,000 for 2 or more in the household) guidelines to be eligible for MA.
To apply, complete the PA 600 Form and mail the application along with supporting documents that show you are undergoing active treatment to the local County Assistance Office. The applicant will be contacted by the CAO to schedule a face-to-face interview upon receipt of the application. It is possible to apply for MA in person and get an interview on the same day. Be sure to have all required documents when going to the CAO.
NOTE: Since there is a nine-month lifetime limit for eligibility under this category its best to try to qualify for MA under another category first.
For more information on Medical Assistance eligibility, see our MA Eligibility Page.
Single County Authorities Drug and Alcohol Treatment Programs== If you do not have health insurance and are not eligible for Medical Assistance under the program described above, contact the Pennsylvania Department of Health Single County Authority (Drug and Alcohol Program) in your county for information on ways to access services.
When you call your county Single County Authority you will be scheduled for an assessment to see what type of treatment you need. You will also be asked about your income to see if you can afford to pay for part of your treatment. The levels of drug and alcohol treatment available through the county include:
- Partial Hospitalization
- Intensive Outpatient
- Halfway House
- Hospital Detoxification
- Hospital Rehabilitation
- Methadone Maintenance
The County has different ways of paying for your treatment when you have no insurance. Whether or not you get the type of treatment you need depends on the money the County has available. However, some level of treatment should always be available to you.
Accessing Drug and Alcohol Treatment Programs For Children
To get drug and alcohol treatments for children, you should follow the same steps listed previously depending on the type of health insurance coverage your child has. Remember that children who receive medical assistance are entitled to any treatment that is medically necessary.
If your child is on CHIP, she will also receive some drug and alcohol services. The following types of drug and alcohol treatment is available through CHIP:
- Up to 4 inpatient detoxification admissions (of up to 7 days per admission) in a lifetime
- Up to 30 days per year of non-hospital residential treatment (with a 90 day lifetime cap)
- Intensive Outpatient
- Up to 30 days of outpatient or partial hospitalization per year
Read your CHIP Member Handbook or check with your plan directly to see what other drug and alcohol services may be covered. See our Publications Page for more information on accessing drug and alcohol services for children.