Unlike many other healthcare organizations, Carisk has a sole focus on behavioral health issues. As such, the organization provides psychiatric and physical evaluations that help to create treatment plans for individuals who need substance abuse treatment, addiction treatment, behavioral health help, or support with pain management issues. Members of the system are given access to the network of healthcare providers and additional specialty programs tailored to their long-term and immediate needs.
Carisk works for and with a wide variety of different institutions and entities, including health maintenance organizations, Medicare and Medicaid regulators, self-funded and commercial employers, colleges, and universities. The state of Florida has licensed Carisk as a Third Party Administrator in Insurance Regulation, meaning that the company takes on the claims processing of their clients.
Services Provided by Carisk
- 24/7 care access, even with telemedicine services
- Opioid addiction, pain management, and clinical programs regarding substance abuse
- Healthy lifestyle support
- Behavioral health treatment for individuals in early childhood and adolescence
- Prescription drug reviews and ongoing medication management
The primary purpose of Carisk is to evaluate individuals and match them with the appropriate treatment for their situation.
How It Works
So how does Carisk fit into all of this?
The purpose of Carisk is to simplify the process of matching patients with ideal treatment methods. The company’s clients are insurance companies, and the members are individuals with policies through the clients. In most situations, insurance companies have to rely on the word of a doctor or other healthcare professional they’re unfamiliar with. Carisk employs counselors who can evaluate a person’s situation and case, and from there, create a treatment recommendation.
If you need treatment for a substance use disorder, a Carisk professional will meet with you to discuss your situation in a private counseling session. Based on the information they gather, they will make a judgment regarding the type of care you need. This recommendation will be sent to your insurance company, who will then pre-authorize the treatment.
Carisk is in charge of determining what level of treatment should be provided based on a mental health evaluation. This includes:
- Whether inpatient supervised detox is necessary
- Whether residential rehabilitation services are essential to recovery
- What level of outpatient care is appropriate in lieu of a residential stay
- Whether the individual’s home environment is a supportive place that will foster recovery
If you don’t agree with the decision made, you can discuss concerns with a staff member by contacting the Member Services division of the company.
When the company authorizes any level of behavioral healthcare, there are just two factors that are taken into account:
- Whether the level of care is appropriate to the circumstances and likely to foster a positive outcome
- Whether the individual’s existing policy with the client contains coverage for the level of care
No employees of the company or representatives receive any financial rewards for denying care. The judgment of your case evaluator is based on the facts of the case alone, rather than based in a desire to deny you insurance coverage.
Carisk will work within the framework of your existing policy. If you have a policy that states that residential rehab treatment will not be covered, then Carisk will not recommend residential treatment. If you want to pursue residential treatment, you’ll have to pay for it out-of-pocket. In the same vein, if your policy states that your company will cover seventy percent of residential treatment, then Carisk may recommend residential treatment that utilizes that seventy percent of coverage.
If you don’t agree with the decision that’s made, you can send it through an appeals process. Every case appeal is reviewed by a psychiatrist or another doctoral level mental health practitioner who had no involvement in the original ruling. You can also appeal decisions for external review by submitting them to the Agency for Health Care Administration in Florida.
If you plan to start an external appeal, Carisk must be notified with a written statement that you intend to begin the appeals process with the AHCA. This notice must be submitted within the thirty-day period following the date that you received your internal appeal ruling.
Paying for Rehab
Carisk exists as part of the authorization process for rehab and other substance abuse treatment services. Once a Carisk provider has created a treatment plan, that treatment plan will be covered under the specifications outlined by your policy.
Ask your health insurance provider the following questions:
- Will my insurance cover inpatient detoxification services, and how much of the cost will be covered?
- Will my policy cover residential rehab treatment?
- Will my policy cover partial hospitalization or intensive outpatient programs?
- Are there limitations on the outpatient services I can access in a year?
- What will my copay for services be like?
- What are the differences coverage-wise between seeking in-network treatment and out-of-network treatment?
- Will my policy cover dual treatment of co-occurring mental health disorders?
- Will my policy cover relationship therapies like family counseling?
- Are there any other limitations to my coverage that I should be aware of?
Keep a pen and paper by you and write down all the answers. It will help you when you’re discussing your potential treatment options with the Carisk representative.
Covering What Your Policy Won’t
The majority of people won’t have one hundred percent of the costs covered by their insurance policy, regardless of the treatment method. You still have to worry about whatever deductibles and copays are part of your plan. Also, many insurance companies will only cover a certain percentage of treatment, leaving the rest to be paid out-of-pocket.
The cost of this can add up quickly. You may be able to get a long-term payment plan or borrow money from family members. One thing to keep in mind, though, is that some treatment is always better than no treatment.
Maybe you could benefit from a residential stay, but you can’t afford it. That doesn’t mean you shouldn’t get treatment at all. Enrolling in any outpatient care will do you more good than giving up.