<i>60 Minutes</i> Covers Utilization Review Process

60 Minutes Covers Utilization Review Process
A recent 60 Minutes episode scrutinized cases where insurance companies denied mental health care coverage through the utilization review process. Utilization review is the process where the care plan submitted by a clinician to a patient’s insurance company is reviewed for necessity (whether or not the care will be beneficial to the patient and improve their health) and therefore whether insurance will pay for the care. 

ASAM’s Take:
In addiction care, both managed care companies and care providers often struggle to agree on a patient's care plan.  can serve as a basis for making a care plan based on patient needs and risks -- in fact, The ASAM Criteria is the most widely used treatment guideline and is required in over 30 states.  By creating a care plan based on The ASAM Criteria, clinicians and insurance companies can ensure that patients receive care in least intensive and most appropriate setting. 

Early in 2015, ASAM will release The ASAM Criteria Software.  The ASAM Criteria Software  provides counselors, clinicians and other treatment team members with a computer-guided, structured interview for assessing and caring for patients with addictive, substance-related and co-occurring conditions.  The software uses research-quality questions (including tools such as the ASI, CIWA and CINA instruments) to generate a comprehensive patient report, that details DSM substance use disorder diagnoses, severity and imminent risks as well as a recommended level of care determination.   Because the software provides the addiction field with a standardized and accurate assessment of patient need and a care recommendation, it has the potential to revolutionize and vastly expedite the utilization review process. 

What You Can Do:
 to ensure you receive the latest updates from ASAM and stay tuned for release information about ​The ASAM Criteria Software. 

Make sure you have the latest edition of The ASAM Criteria or . Be sure to review the section on working effectively with managed care.  ASAM criteria trainings are available online at www.asamcriteria.org.  

Know of a violation of Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)?  Get involved! ASAM is a member of the Parity Implementation Coalition. You can follow their activities and learn more at http://www.parityispersonal.org/. You can also learn more about ASAM’s advocacy efforts here.

Watch the full 60 Minutes episode here.