Frequently Asked Questions
Inpatient, Residential & Hospital Aftercare: First Step Services, LLC provides Intensive Outpatient and General Outpatient aftercare for people completing and returning home from inpatient programs & hospitals across the country. We provide intensive group therapy, continuing care, family counseling, individual counseling and other services as needed. The goal is to continue treatment and recovery while one transitions back into community living, returning to work, and resuming a “normal” lifestyle after completing inpatient or hospitalization. We provide this service at all our locations. We can even begin meeting with you by video conferencing before you leave your inpatient facility to ease the transition.
The First Step Services, LLC Professionals Program is provided in discreet, private settings at all our locations. The privacy of the Professional is of primary concern to both First Step and the professional. Upon arrival, a thorough Comprehensive Assessment is conduced with a credentialed professional counselor. The First Step counselors are full time staff member, not a contract employee like is found at most agencies. Upon completion of the assessment, the counselor and Professional determine a recommended level of care and create a schedule that works best for the Professional. That schedule can be morning programs, evening programs and at our Raleigh facility, a program that includes Saturday services. Upon completion of the primary care level of services, the Professional often attends our weekly Aftercare Program. Aftercare provides weekly 90 minute therapy groups for up to one year of attendance at our Raleigh and Durham facilities. The participants in the one year program are doctors, nurses, airline pilots, business executives, and others with similar professional responsibilities.
I have a legal charge, can I choose a different agency rather than the program at the Courthouse?
For DWI, state laws require that you have freedom to use any program you choose to provide services. For other charges, check with your attorney. In most counties you can choose any program that meets the standards at the courthouse. Unfortunately, requires most people charged with alcohol and drug offenses to attend a single privately owned program. The private program has operated inside the courthouse for 30+ years, uninterrupted. Wake Co. courts usually place people in an education whether the person has no diagnosis or whether the person has a severe problem with alcohol and/or drugs. The only measure of success is whether the offender reoffended within 6-12 months. This practice results in very poor outcomes. Clients typically “succeed” during the course of the 6 -12 month program. Evidence proves the only way to measure life changing outcomes is over a period of 5 years after the person is no longer in a program.
First Step’s prices are lower than the court house program. Our services are highest quality and you receive the outcomes right for your situation. For DWI and under 21 driving after consuming offenses, it is illegal for anyone, including the court, to pressure you to receive services from a specific program. You are free to choose any agency you want. If you are pressured to attend any specific program for DWI or driving after consuming under 21 years of age, contact NC DWI Services. They want to know about such violations. NC DHHS DWI Services 919-733-0566
It depends on the reason for the assessment. If you want treatment because you or someone who cares about you feels there is likely, or possibly, a substance use problem, just bring your payment or co-pay, and insurance card if you have health insurance. Most self-pay assessments cost $55. NCSU student self pay $50 substance use assessments. Most are covered by insurance, though and only cost is the copay. If you do not have a DWI, other legal charge or court case, child custody or divorce issue, domestic violence charge $55 is the standard self pay fee for assessment not covered by insurance.
If the assessment is for a DWI charge, bring a copy of the breath test or blood test (which ever was taken), a certified lifetime driving record from each state in which you are or were licensed or received a ticket, payment of $100 cash or credit card (set by State of NC for all DWI providers), a copy of your ticket if you have it. If you do not have the driving record, we can get that for you online for cost ($11). If you have health insurance, bring your insurance card for DWI assessments, too. If you enroll in treatment insurance will often cover a portion of the costs. We are in network with most health insurance companies. Health insurance will pay for counseling for DWI or other legal situations, but will not pay for alcohol & drug education or ADETS, since they is not considered to be a healthcare need.
For DWI Assessments, we are required by the State of NC to collect the full $100 at the time of the assessment. The State is very strict on this, monitors it closely and audits all licensed DWI programs at least every 2 years to ensure compliance. If the assessment is a referral for school, court, a therapist or doctor, another treatment center, it helps to bring all paperwork or referral information you may have from who referred you. Payment or co-pay will be expected at the time of service for non-DWI assessments.
Contact us for information on cost for assessments. Our prices are competitive with other programs, often lower. We accept walk-ins when possible, but it is better to have an appointment. Call the office closest to you to schedule or click the link to “contact us.”
Treatment typically begins with a need of some type regarding use of a mind altering substance. It could be legal, school, job, or a personal need that has been identified as being related to substance use. The first step is to obtain a comprehensive substance use assessment by a qualified substance abuse counselor. These are typically by a LCAS (Licensed Clinical Addictions Specialists), CSAC (Certified Substance Abuse Counselor) or a high level intern or trainee under the direct supervision of a Certified Clinical Supervisor who holds a LCAS credential. Once the assessment is completed, the client and counselor develop a “treatment plan,” sometimes also known as a “service plan.” The “treatment plan” is typically recommends an initial number of group sessions, individual sessions, & family participation. For participants in programs that are 90 days in duration, treatment plan updates are scheduled each 30 days. For those struggling with depression, anxiety or other mood concerns, a visit with our staff physician is often included in the treatment plan.
Substance use treatment is typically conducted in a group setting. There is usually one counselor, or if the group consists of 12 -15 group members, probably 2 or more counselors are there. Group typically starts with a “check in” to see how everyone is doing that day or since the last group met. Once check in is complete, there is often a topic of discussion presented by a counselor. There is plenty of question/answer during the counselor presentation.
The next part of group is the “process” portion of the group. Participants tend to learn more from each other’s situations, actions, comments, progress, etc. than if just meeting with a counselor individually. There is interaction between participants, both supportive and informative. The value of the group setting is largely provided by peers in the group. The counselors bring a lot of training and experience to the group; but the peers have the current relevant experiences that provide most of the opportunities for learning and experiencing within the group. During this portion, each group member has an opportunity to discuss his/her situation, concerns, etc. regarding substance use; and any effects thereof. This part is usually the longest and, according to most participants, the most valuable.
When a group member(s) has a pressing concern it is usually addressed directly after check-in is completed. There is always time for the counselor to provide presentations and handouts. The primary goal of group is to address recovery & substance use concerns of its members.
Family counseling and education are often a determining factor in successful substance use treatment. Direct family involvement significantly improves the treatment process when siblings, parents, grown or older children get involved with the counselor and the treatment. Family And Community Education (FACE) program at our Raleigh facility is no cost. FACE is a good way for adult family members, friends and significant others to learn more about supporting recovery in addition to helping oneself during the process.
Once the group member successfully completes the program, and is maintaining abstinence & recovery, he/she is welcome to attend our groups for as long as he/she desires for $5 per group. This allows the program graduate ongoing support in the early recovery phase after primary treatment is completed. We have had group members stay as long as a couple of years to assist with their successful ongoing recovery. This could be recovery from alcohol or drug problems or, it could be as simple as recovery from the problems caused by substance use. One does not have to identify as an “addict” or “alcoholic” to benefit from treatment or aftercare!
First Step’s 3 hour groups are 3 hours in duration for several reasons. The primary reason is our experience demonstrates the 3-hour group is clinically sound – offering an excellent opportunity for ending problems caused by alcohol or drug use. Three hours allows participants more time for processing personal concerns.The format requires fewer visits to complete the same number of hours. It helps keep our cost-per-hour rate lower than programs that have 1.5-2 hr groups. Three hour groups cost participants less money and gives better treatment outcomes. Each First Step facility has group schedules available at least 3-5 days a week. Health insurance will usually cover the cost of group sessions. Insurance companies define groups that are 3 hours in duration and are scheduled at least 3 times a week as “intensive” groups. We are in network with all the major insurance companies that operate in our local areas.
See our “Services” page to view the services you may receive at First Step to support your goals. Our number one goal with you is to help you never have another problem related to substance use, whether it is a physical, mental, legal, family, job, school, etc. problem. Our desire is simply to help you put this type of trouble behind you permanently.
The only way we can release any information to anyone is when the client requests it and signs an “authorization to release information” form, sometimes called a “consent to release information.” Without these, we are under Federal statutes requiring absolute confidentiality of all information. Confidentiality is one area all programs have to respect without question. The only exceptions to strict confidentiality are if there is a treat to harm oneself or someone else, a situation in which someone’s life is in danger or evidence of child abuse or endangerment.
Why would someone in treatment want to sign an authorization to release information? Usually it is the result of needing to inform a family member, therapist or doctor, attorney or the court, school or employer, etc. concerning attendance and progress in treatment. Only the most basic information is shared such as if a person had an assessment and, if so, the outcome and recommendation. Diagnoses and personal information are not shared, unless subpoenaed by a court which is rare.
If a person has a DWI, typically there is need to communicate with the representing attorney and the NC DWI Services State office, to complete the process for restoration of drivers license. The State of NC requires a “508 form” be completed online by the assessment and treatment provider. It is then forwarded to their office confirming that all requirements for a DWI assessment and counseling or education have been successfully completed.
Sometimes, employers or schools for example might have referred someone for an assessment and counseling. In those cases reports are usually required by the school or employer verifying that the person is attending and progressing as they require.
Most people who request an assessment and counseling/education request information be passed along to someone about their situation. Family members want to ensure the person they are concerned about is attending, progress, and want to help. Attorneys need letters & reports to help with court cases, DWIs, etc. Employers want to ensure that employees who are recommended treatment follow the treatment plan successfully. For each person in counseling or treatment, there are usually 1 – 3 authorizations to release information requested.
Since First Step is in network with most health insurance, it is usually easy to ensure your services are covered. When scheduling an assessment, tell the person on the phone that you have health insurance. Make sure to bring your insurance card with you when you report for your assessment.
Once authorized, typically the only thing a patient must do is pay the co-pay, and sometimes at least a portion of the deductible. Using health insurance is an excellent way to complete counseling without huge out-of-pocket expenses.
(In this discussion the program participant is referred to as a patient, as is viewed by health insurance companies.)
If you have health insurance, they will usually cover your visits to First Step Services, LLC. First Step is in network with the major health insurance companies,. We do all the billing for you, so you don’t typically have to send anything to your insurance company. When you schedule an assessment, tell the person on the phone that you plan to use insurance to assist with paying for services. When you come in, be sure to bring your insurance card with you. We cannot accept insurance until we actually have a copy of both sides of the card. Most insurance companies will not pay for services that occurred prior to the up to date card being presented to us. If you are insured under a parent, spouse, or other person the insurance forms require that we have that person’s full name, date of birth, address and insurance ID number. Without this information, we can’t submit claims.
It always helps to arrive a few minutes early for your first visit. Once you arrive and check in, as part of the “intake” process we will ask you to complete a “CMS1500 form” which provides the basic information that the insurance company will require that we provide to them. If your insurance is in the name of a spouse, parent or any other person, you will need to include their full name, date of birth, employer’s name, etc.
Since First Step is in network with all the major health insurance companies, we do all the billing for you. You do not have to send invoices to your insurance company. Once we get a copy of your insurance card, we get per-authorizations and re-authorizations as needed. Once you begin attending sessions, we submit invoices to your insurance company. Your insurance company will send a copy of the “EOB” (Explanation of Benefits) or “EOP” (Explanation of Payments) to you. This way, you will know the status of your claims. If you have questions about the claims, you can call us at (919) 933-8899.
Am I responsible for contacting my insurance company?
The initial appointment typically doesn’t require per authorization, but it doesn’t hurt if you call your insurance company to verify that. If you don’t have an opportunity to call the insurance company, no problem, just come on in. Some insurance plans pay for the assessment but some do not. Most plans that do pay for the assessment only pay for it if you actually start the program and there is billing for counseling or treatment. These companies consider the assessment a part of treatment and don’t pay unless billing for treatment is begun. Since it is viewed as a healthcare concern, some insurance companies expect their customers to begin receiving services within 72 hours (or 3 days), after the assessment. Otherwise, they could view it as unnecessary.
My insurance is through my employer; will my employer find out that I come here if I use my insurance?
Insurance companies will not inform your employer, or anyone else for that matter, about your treatment. All health records, especially substance use treatment, are protected by Federal law and cannot be shared. There are only a very few exceptions. If one is suicidal, homicidal or there is evidence of child abuse or endangerment appropriate notifications are made under very strict guidelines. Your confidentiality is of utmost importance.
What does co-insurance mean and why do I have to pay that?
Concerning cost, typically the only thing a patient must do is pay the co-pay, and sometimes at least a portion of the deductible. Most co-pay is around $25 per session. Sometimes deductibles come into it and, when they do, we do everything we can to help alleviate some costs. Even though it is much less than the insurance contracted rates, we allow people to come to treatment and pay the “hardship rate” until the deductible is met. Co-insurance is a cost sharing method that some insurance plans require. Depending on the reimbursement rate, it usually results in no added cost to the patient.
I have a high deductible how will using insurance help me?
Is it worth using insurance with a high deductible? Yes, it is best to use it. It will help pay down your against your deductible. For more information on how we work this out, call First Step. Our goal is to help you get through treatment and not break the bank.
Will my insurance company use this treatment against me in the future to raise my rates?
Using your health insurance to cover your treatment should not increase your rates. The Federal Government enacted a “mental health parity law” a few years ago, requiring insurance companies to treat substance use treatment in the same manner it handles any other doctor’s visit or service. We don’t know of increases happening as a result of treatment. Patients & former patients tend to keep us informed of most things like it.
What happens if my insurance stops covering my treatment?
By being in network, we help our patients & clients not have to risk the pitfalls of using an out of network provider. If you lose your insurance or are no longer authorized after some sessions, we reduce your cost to our typical “hardship rate” which is significantly lower than the insurance contracted rates. If you lose your job and are no longer able to pay anything, we will discuss options with you. We can usually work out a financial plan that works both for you and First Step.
The number one reason for delays in getting drivers licenses restored is the client did not inform the assessing agency of the conviction date. DWI assessment & counseling agencies have no means of knowing when a case is resolved in court, whether conviction or dismissal. Until we are notified that the case has been resolved and the outcome date, a “508” form cannot be completed. The “508” form is the document the State of NC requires to process the paperwork allowing for restoration of driving records. The correct conviction date is absolutely required for the State of NC to release a drivers license for restoration. It is always up to the client to notify the DWI assessment agency of the conviction date or drivers licenses cannot be restored until that time.
Completion of a “CMS 1500 form” is necessary upon arrival on which you will fill out all pertinent information to have your services paid for by insurance. The “CMS 1500 form” also contains a built in “authorization to release information” to them, so we can get your services reimbursed.
Insurance companies vary on how they reimburse for the assessment. Some pay for assessments as a single service; most only pay for the assessment as part of treatment. In these cases, actually entering the treatment program is required by the insurance company to reimburse for the assessment. Insurance will not pay for education-level classes such as ADETS, S.A. Education, ACE, etc.
Once the decision is made by the client to enroll in treatment or counseling, the counselor will call the health insurance company for “authorization to provide services.” Authorization is usually given for a person to receive treatment, no matter what the diagnosis. One doesn’t have to be an “addict” or “alcoholic” for insurance to pay for treatment. In fact, our field is in some ways doing away with those labels.
Once authorization is gained, the insurance company has several requirements such as motivation to successfully achieve abstinence, good attendance, appropriate participation in discussions, family involvement and support, attendance at community support programs, abstinence during the course of treatment, etc.
Authorization is usually for a few sessions at a time, but on occasions, an entire program may be authorized up to 30 sessions. When more sessions are needed, the counselor has to call the insurance company again to request authorization for more sessions. The request for more sessions involves the insurance company asking questions such as in the above paragraph. They will use the answers to those questions to determine how seriously the patient wants to achieve the same goals they are looking for.
Insurance companies typically require a co-pay, but some plans do not. If a co-pay is required, insurance contracts require that the co-pay be paid prior to service being rendered, at “check-in.” Sometimes there are deductibles to be met. In these cases, we require partial payment at check-in and the patient is billed for the balance, so the patient doesn’t have to pay the entire insurance contracted rate at each visit. We know that is too expensive for some people.
We often don’t know for sure how much a person has to pay until we receive and “explanation of benefits (or payment) from the insurance company. Be aware that insurance companies handle substance use & mental heath coverage differently than they do most typical medical services.
Health insurance will pay for all levels of care except education classes, such as ADETS, ACE, Drug Education. Insurance will typically pay for early intervention, short group programs such as 7-10 3 hour group sessions.
DWI and other mandated assessments maybe partially covered only if one is enrolled in counseling. In that case when reimbursement is received, it is usually applied to cover upcoming co-pay expenses. Insurance companies do not like to pay for assessments that recommend counseling if the person does not attend the counseling.
Health insurance does not cover reports, letters, and other case management needs. NC DWI laws require that the assessment is paid for in full by the client, $100. Health insurance companies pay for treatment related to health care reasons. A person may come in with a DWI, no significant problem with substance use but has to attend a 20 hour program due to a high breathalyzer reading. Insurance will typically pay for the counseling because the legal situation could indicate a looming potential healthcare problem that they would prefer to help prevent. It doesn’t mean one currently has a serious substance use issue.
We do everything possible to help our program participants keep costs down and the best way is with health insurance. Please feel free to contact us for more questions!
What are the forms of payment?
We do all the billing and assist with authorizations. If you have insurance it is sometines helpful for you to contact your insurance company and ask for authorization after your assessment and prior to entering counseling. This ensures the most likelihood that they will assist you with cost.
We are in network with the following insurance companies:
Cigna, Blue Cross Blue Shield, NC State Employees Health Plan and Federal Blue Cross, United Behavioral Healthcare, Magellan, MedCost, Well Path, Aetna, Value Options, Managed Health Network, CompPsych, Health Net (for working with US Military Veterans).
Self Pay/Cash: Allows those without insurance to pay cash for services at a discounted rate if paying the full rate could cause financial hardship. Our self-pay cost is among the lowest in the area. Payment plans may be arranged for post-trial DWI clients on a case-by-case basis.
The State of NC sets the ADETS fee at $160 for NC-DWI “508” clients. Fees paid to NC DWI Services assists clients with the cost manuals for NC DWI (508) clients.