Fighting Addiction TogetherWe Do RecoverWhat do I say when a treatment center calls me back?
The phone rings, it is the center, and your heart is going. Here is what that call is actually for, what they are going to ask you, and the handful of things you should ask them before you say yes to anything.
Tell them the truth about what you use, how much and how often, what medical problems you have, and what insurance you carry, then ask three things back: whether they are the treatment center or a referral service, what the stay will cost you out of pocket, and what happens if you slip once you are in their program. Have your insurance card, your medication list and a pen next to you, and do not agree to a bed on that first call unless you already know who is on the other end of it.
And if you would rather have that first conversation with somebody who has been where you are and has no bed to fill, reach out first. One of us will call you, we will talk it through, and you will take the center's call already knowing what to ask.
What the call is actually for
The callback has two jobs. The first is to figure out what level of care you need: detox, residential, outpatient, or a doctor and a phone number. The second is to figure out how it gets paid for. Both of those are legitimate. A program cannot admit you without knowing what you are withdrawing from, and it cannot keep the lights on without knowing who is paying. The only problem is when the second job crowds out the first, and you will feel it when it does.
I train the people who make these calls. Nobody at my page gets paid based on what you decide, and I write pages like this one so the call goes the way it is supposed to go. The tell is order. A good rep asks about you before they ask about your card. If the first real question is "who is your insurance through," you are not talking to a clinician, you are talking to a sales floor, and it is fine to say so and hang up.
What they are going to ask you
Expect these, roughly in this order, and answer them straight.
- What you use, how much, how often, and when you last used. This is not judgment. The nurse who admits you has to know whether you need medical detox, and that depends on the substance, the amount and the timing.
- Medical history and mental health history, including every medication you take. Say the names even if they are embarrassing. Say the gas station stuff too. If you take 7-OH every day, say the brand and the dose, because the person prescribing your detox meds needs to know it is an opioid and most of them will not recognise the name on the pouch.
- Whether you have been to treatment before, where, and what happened.
- Your insurance. They will ask for the card, front and back, and the date of birth of the policy holder. That is the verification of benefits and it is normal.
- Where you are right now and whether you can travel, and whether anyone can drive you.
When the rep calls back and says "you are approved," ask what exactly was approved. HealthCare.gov defines preauthorization as a decision by your plan that a service is medically necessary, and then says plainly that "preauthorization isn't a promise your health insurance or plan will cover the cost." So ask how many days were authorized, at what level of care, what your deductible and out of pocket maximum are, and what happens to the bill if the plan stops authorizing on day nine.
What to have next to you
Your insurance card. A written list of everything you use, with amounts. Your medications, or the bottles. A pen. And if you can, one person you trust on speaker, because you will not remember half of what gets said. Nobody who is serious about helping you will object to your sister listening in.
What to ask them back
Are you the treatment center, or a referral service? Ask it in exactly those words. The ad you clicked does not tell you which one answered.
Google's own advertising policy allows "lead generators or referral agencies for addiction services" to run ads under the same certification as clinical treatment providers, so the search result looks identical either way. Paying anyone for a referral to a treatment facility is a federal crime under the Eliminating Kickbacks in Recovery Act, up to ten years per occurrence, and yet a 2017 House Energy and Commerce memo on patient brokering described brokers offering "scholarships," free housing and cigarette money to steer people into particular facilities, and a case where a treatment center's Google listing was hijacked and its phone number swapped for a call aggregator. That is why the first question is who you are talking to.
What will this cost me, in dollars? In network or out of network. Deductible. What you owe if insurance denies days. If they cannot answer, ask them to send it in writing before you get in a car.
What happens if I slip once I am in your program? I have written about this before on the page about what a real program does. Ask the outpatient program what happens if you drink one beer. Some places restrict you for a week and stabilize you. Some send you back to detox and it turns into thirty days. Neither answer is evil. You just need to know which one you are signing up for.
How many one on one sessions with my own therapist do I get every week? Group does not count. Two is the floor. A lot of places sell "individual therapy" and deliver one 45 minute session.
Who calls me after I leave? A program that ends at discharge is a detox with a longer hallway.
The full list is on Questions To Ask. You do not have to ask all ten on the phone. Ask the ones above, and you will know more about that place than most people know after a month inside it.
Things you are allowed to say
"I need a minute." "Send that to me in writing." "Can my brother be on this call?" "I am not booking anything today." A real program hears those and says of course. A pitch hears those and gets faster.
Being desperate does not mean taking whatever is in front of you. I know how the urgency feels, and I know the people who make these calls are trained to lean on it, some of them kindly and some of them not. You are allowed to want it and still ask a question. You do not go back fifty times if you do not want it, so the wanting is not the part I worry about. The part I worry about is you saying yes to the first voice that sounded sure.
What you tell them stays with them
The reason to tell the truth on the call, the real numbers, is that the truth is protected.
Under 42 CFR Part 2, a federal rule that covers "any federally assisted program that provides SUD diagnosis, treatment, or referral for treatment," a program "cannot share any information that would identify someone as having, or having had, a substance use disorder" without your written consent, outside of narrow exceptions like a medical emergency or a court order. That is a higher bar than ordinary medical privacy, and it exists because people lie to intake nurses out of fear and get hurt in detox because of it.
If you would rather not call a center yet
You do not have to start with a center at all. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential, open 24 hours a day every day of the year, in English and Spanish, and it is a referral and information service run by the federal government, not by a facility. And our own reach out form goes to somebody who has been where you are, who is not paid based on what you decide, and who will talk it through with you before you talk to anyone with a bed to fill. If you are using tonight and you are alone, Never Use Alone is 800-484-3731.
What to do next
Print or screenshot Questions To Ask before the phone rings. If the number you called turned out to be a middleman, this page shows you how to tell in ninety seconds. If you have no insurance, start here instead. And if you want a human first, reach out and one of us will call you.
Sources
Preauthorization definition, including "preauthorization isn't a promise your health insurance or plan will cover the cost." HealthCare.gov glossary, U.S. Centers for Medicare and Medicaid Services: healthcare.gov
Addiction services advertising policy, listing "lead generators or referral agencies for addiction services" among certified advertiser types. Google Advertising Policies Help: support.google.com
Eliminating Kickbacks in Recovery Act, 18 U.S.C. 220, fines up to 200,000 dollars and up to 10 years imprisonment per occurrence. Legal Information Institute, Cornell Law School: law.cornell.edu
Memorandum for the hearing "Examining Concerns of Patient Brokering and Addiction Treatment Fraud," December 9, 2017. U.S. House Committee on Energy and Commerce: democrats-energycommerce.house.gov
Understanding Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2. U.S. Department of Health and Human Services: hhs.gov
SAMHSA National Helpline, 1-800-662-4357, free, confidential, 24/7, 365 days a year, English and Spanish. Substance Abuse and Mental Health Services Administration: samhsa.gov
If any of this is your life right now
Leave your name and a number and somebody who has been through it calls you back, usually within a few minutes. Nothing to sell, nothing to sign.