Glossary
Every word nobody explained.
40 terms. One sentence each.
- Accreditation
- An outside quality review, most often by The Joint Commission or CARF. It is voluntary and separate from a state license.
- Allowed amount
- The price your plan decides a service is worth. Out of network, anything billed above it can land on you.
- ASAM criteria
- The national guidelines clinicians use to match a person to a level of care.
- Balance billing
- A bill for the gap between what the provider charged and what your plan allowed.
- Body brokering
- Another name for patient brokering.
- Coinsurance
- Your percentage of each bill after the deductible. 20% is common.
- Concurrent review
- Your plan re-approving a stay a few days at a time while you are still there.
- Contingency management
- Earning rewards for meeting goals such as negative drug tests.
- Copay
- A flat fee for a visit or prescription.
- Cross-tolerance
- Tolerance to one drug carrying over to another in the same family.
- Deductible
- What you pay each year before your plan starts paying.
- Dependence
- Your body has adapted and gets sick without the substance. Not the same as addiction.
- Detox
- Medical care while a substance leaves your body.
- Dual diagnosis
- A substance use disorder and a mental health condition at the same time.
- Explanation of benefits (EOB)
- A statement from your plan showing what was billed, what it paid and what you may owe. It is not a bill.
- Fentanyl test strip
- A paper strip that detects fentanyl in a drug sample.
- Good Samaritan law
- State laws that protect people who call 911 for an overdose.
- Harm reduction
- Practical steps that lower the risk of dying or getting sick, whether or not someone stops using.
- In-network
- The provider has a contract with your plan and has agreed to its prices.
- IOP
- Intensive outpatient. About nine hours of treatment a week.
- MAT
- Medication-assisted treatment. FDA-approved medication plus counseling.
- Medical necessity
- The plan's standard for whether it will pay for a level of care.
- Naloxone (Narcan)
- A nasal spray or injection that reverses an opioid overdose.
- Out-of-network
- No contract. The plan pays less, or nothing, and the provider may bill you for the difference.
- Out-of-pocket maximum
- The most you pay in a year for covered, in-network care. After that the plan pays 100%.
- Parity
- The federal rule that mental health and addiction benefits cannot be more restrictive than medical benefits.
- Patient brokering
- Paying or being paid for steering a patient to a facility. Illegal.
- PAWS
- Post-acute withdrawal syndrome. Mood, sleep and focus problems that can come and go for months.
- Peer support specialist
- A person in recovery trained to support others. Not a therapist.
- PHP
- Partial hospitalization. Full days of treatment, sleep at home.
- Relapse
- Returning to use after a period of not using. Common, and not the end.
- Single case agreement
- A one-time contract so an out-of-network provider is paid as if in-network.
- Sober living
- Shared, substance-free housing. Not treatment.
- Sponsor
- In 12-step programs, a member with more time who guides you through the steps.
- Superbill
- An itemized receipt you send to your plan to ask for reimbursement.
- Tolerance
- Needing more to get the same effect.
- Utilization review
- The process your insurer uses to decide whether to keep paying for care.
- Verification of benefits (VOB)
- A facility calling your plan to find out what is covered. It is an estimate, never a guarantee.
- Withdrawal
- What the body and mind go through when a substance is reduced or stopped.
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