Wellsense

The New Hampshire Drug Monitoring Initiative reports that there are close to 30 overdose deaths each year per every 100,000 residents. In 2019, the New Hampshire Department of Health and Human Services (DHHS) reported that an estimated 409 people died from drug or alcohol overdose. According to this same report, nearly 2,000 doses of Narcan were administered by Emergency Medical Services for potential opioid overdoses and 5,562 people were admitted to emergency rooms for opioid-related reasons. The DHHS report concludes by asserting that 3,609 admissions for drug or alcohol use disorder treatment happened. Eighty-four percent of these admissions were for opioids.

Alcohol and drug dependence in addition to substance use disorders disrupt lives, families, work, and futures. Seeking help is one of the most difficult and brave things you can do. If you have determined you have a problem and need help, you deserve to know exactly what your options are. To avoid additional financial stress, it is vital to know whether your insurance will cover treatment, as well as what treatments are covered by your individual plan.

For those insured through Medicaid in the state of New Hampshire, this question is no less pressing. Luckily, there are several options for partially and fully covered treatment for alcohol and substance use. Among your New Hampshire Medicaid options is the Well Sense Health Plan.

What Is Well Sense?

Well Sense is a not-for-profit organization contracted by the State of New Hampshire. The Well Sense Health Plan is one of the official Medicaid coverage plans for New Hampshire residents. Well Sense is what is known as a managed care organization, or MCO. New Hampshire’s partnership with Well Sense began on December 1st, 2013.

Well Sense is a subsidiary of Boston Medical Center Health Plan, Inc., an organization that also provides Medicaid benefits to Massachusetts residents. The National Committee for Quality Assurance (NCQA), an evaluator and accreditor of high-quality state healthcare plans, has given Well Sense the status of Commendable Accreditation.

What Is Generally Covered by the Well Sense Health Plan?

Well Sense functions much like private health insurance. It covers a portion of certain doctor visits, diagnostic services, treatments, inpatient and outpatient care, and prescriptions. While some of the responsibility for payment resides with the plan holder, the New Hampshire Medicaid system pays for all deductibles and monthly fees. In fact, depending on the age, income level, and state of health of the plan holder, there may be very little to no financial responsibility for many medical services.

Related Well Sense Services

The Well Sense Health Plan is designed to give you the broadest possible care with the greatest accessibility. Well Sense can help you find a physician through its Provider Directory. You can also search for pharmacies and find out which medications are covered by your Well Sense plan. There are also Care Management Programs for chronic disorders like asthma, diabetes, and other long-term health issues.

Alcohol and Substance Use Disorder Treatments

What follows is a breakdown of the drug and alcohol treatments that may be covered under your Well Sense Health Plan policy. In order to find complete information about your specific coverage, you need to ask an agent of the Well Sense organization. See the section called “How to Obtain Prior Authorization” for that contact information.

No information or statement made here should be considered a guarantee of payment for treatment. Detailed information about alcohol and substance use treatments may be found in the sections called “Substance Use Disorder (SUD) Treatment Services,” “Inpatient Mental Health Services,” and “Outpatient Mental Health Services” of the Well Sense Health Plan Member Handbook. These last two sections may be found in the Benefits Chart division of the Handbook.

Several types of treatments for alcohol and substance use disorders are typically covered by the Well Sense Health Plan. These treatments range from one-on-one outpatient services and residential rehabilitation stays to relapse prevention and maintenance.

As you seek help for a substance use disorder, you will initially need to be tested for the amount of the substance in your system. You will also need to answer some questions concerning the length and amount you use. This will help an expert to determine whether a medical intervention such as withdrawal management is required.

Next, you will be referred to a particular type of treatment or treatment center. These can be generally grouped into two categories, outpatient and inpatient. Some treatments are hybrids of the two categories. An example of this is a partial hospitalization program, which has aspects of both inpatient and outpatient care. These basic categories are further broken down as peer or non-peer and medical or non-medical.

To begin, either a medical doctor or other medical professional, such as a psychologist, psychiatrist, social worker, or counselor, will help you decide the best course of treatment. Outpatient treatment can be individual counseling, which may or may not also provide group therapy, or it may be a peer-centered outpatient treatment center. All or part of the counseling services may be covered by your Well Sense Health Plan. Outpatient is usually best for less severe cases when the patient needs to attend to home, work, or other obligations.

Outpatient services that may be covered include individual, group, and family therapies, intensive outpatient treatment, and medically monitored outpatient withdrawal management, also called medical detoxification or simply “detox”. Intensive outpatient treatment services are typically performed under the clinical model, in which medical and mental health professionals work together to design the optimal course of treatment.

Inpatient services are often recommended for severe cases and for individuals who have a history of relapsing. Opioid treatment may or may not be inpatient, depending on the type and amount of opioids used. Medication-assisted treatment for withdrawal management and medication exchange also may be either inpatient or outpatient. When these are done in tandem with either a short-term hospital stay or regular visits to a hospital or clinic, they are called partial hospitalization programs, or PHPs. Treatments in which you are able to leave the hospital are categorized as “ambulatory.”

Medically monitored residential withdrawal management, which is referred to as “non-ambulatory,” is an inpatient treatment option that might be covered. Stays range from between a week for withdrawal management to longer periods, which are typically either two weeks, one month, or two months, depending on the decision you and your doctor or healthcare professional make together. Specialty treatments for those with disabilities or pre-existing conditions, as well as treatment for women who are pregnant or in their postpartum period, may all be covered by the plan.

Residential treatments may include a stay at a rehabilitation center. This is often called “going to rehab.” While there are many assumptions about rehab, modern residential treatment centers can provide a variety of treatments tailored to your recovery needs. Choosing to go to a rehab center for a longer period of time is a difficult decision, since it may impact both home life and work. However, not receiving treatment could have even more devastating consequences.

Services That Are Not Covered by Your Well Sense Health Plan

There are many free programs, such as Alcoholics Anonymous and Narcotics Anonymous, as well as programs funded by your federal and state governments that include halfway houses and other group and individual treatments. Since they are free or low cost, these and any related expenses, such as transportation, are not covered by your Well Sense Health Plan.

How to Obtain Prior Authorization

Most services, including substance use disorder treatment, require prior authorization before they can be covered by Well Sense. It is vital that you check to see if you need prior authorization and to obtain it before you enter into any treatment agreement. In order to obtain prior authorization, you must contact the Well Sense Member Service Line. This number can be used 24 hours a day, seven days a week to obtain information about your individual coverage.

Coverage Abbreviations

When seeking prior authorization, the following list of abbreviations will help you and your Well Sense customer service representative identify the category your proposed form of treatment falls under.

• APRN: Advanced practice registered nurse
• FQHC: Federally qualified health center
• LADC: Licensed alcohol drug counselor
• MLADC: Master licensed alcohol and drug counselor
• PHP: Partial hospitalization program
• RHC: Rural health center
• SBIRT: Screening, brief intervention, and referral to treatment
• SUD: Substance use disorder

Your Medical Information and Privacy Rights

Many people avoid treatment because of the social stigma that exists if friends, associates, or your employer find out. However, your privacy is protected under the law within reasonable limits. Under most circumstances, the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA) protects your right to either disclose or not disclose your substance use, or any other health issue, to your employer. Further information about your rights to privacy and discretion when it comes to alcohol or substance use may be found at the U.S. Department of Health & Human Services web site.

Treatment Options at Green Mountain Treatment Center

Short- and long-term rehabilitation services may be found at Green Mountain Treatment Center, a member of Granite Recovery Centers. Green Mountain is set up to perform all but emergency-level medical detoxification. All treatment options are created in consultation with the National Registry for Evidence-Based Programs and Practices (NREPP), an organization which is overseen by the US Substance Abuse and Mental Health Services Administration (SAMHSA)

Based on the 12-step Alcoholics Anonymous curriculum, at Green Mountain, we offer integrative and diverse therapeutic options. Our staff works with you to develop a highly individualized treatment plan that is best suited to your specific recovery needs. Our center for men and women ages 18 and older is nestled in New Hampshire’s White Mountains, providing a scenic and secluded location in which recovery can proceed with minimal distractions. Green Mountain is Granite Recovery’s main drug and alcohol rehabilitation center.

Green Mountain clients are paired with peers who are further along in their recovery. This helps ensure a steady and easy transition into the rehab environment. This is referred to as Green Mountain’s Peer-to-Peer Program. Residents are separated by gender, and treatment occurs on both individual and small group levels. In addition to traditional psychological and medical treatment, holistic therapies including yoga, meditation, and exercise are employed to treat the whole person, not just the disorder. A full-time gym exists on the Green Mountain premises.

Psychological services at Green Mountain include cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychotherapies for comorbid mental disorders. Specialized treatment exists when anxiety, panic disorder, depression, post-traumatic stress (PTSD), or other mental health disorder cooccurs with substance use disorder. There is also loss and grief counseling. All clinical treatments are evidence-based, employing the latest research in the substance abuse field.

Transportation to and from Green Mountain is available. After your stay at our center, continuing therapy, upkeep, group support systems, and substance use tests may be available, based upon your insurance coverage.

Interviews and intake can occur at any time of day. You may contact Green Mountain 24 hours a day, seven days a week, 365 days a year. Once you have determined your level of coverage, it is always best to seek treatment as soon as possible. The earlier the intervention, the better.

You owe it to yourself and your family to overcome substance use disorder. With the knowledge above, you are now armed with options. These will allow you to take action and make healthy choices. You have the power to decide that today is the day to begin your path to sobriety.

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