This blog entry is available to download -please consider sharing with current and former clients and their families who may be interested in insurance reimbursement for their OBH treatment: Insurance Coverage For Wilderness Therapy_OBH Council.  Full document also follows below:

Insurance Coverage for Wilderness Therapy

In the past twelve months, there have been some important strides in receiving insurance reimbursement for intermediate outdoor behavior health (OBH) programs, sometimes referred to as “Wilderness Therapy.” The insurance landscape is fluid and ever changing, requiring regular updates for current and past parents of wilderness therapy families. Please visit the OBH Council website’s blog page for ongoing updates.

Some Background

Insurance coverage is continually changing, covering greater services, particularly regarding mental health and substance abuse coverage. Understandably, insurance companies only recognize established mental health practices, which historically fell generally into inpatient hospitalization and outpatient therapy. As mental health professionals establish a new and effective treatment modality, insurance companies begin recognizing and authorizing it for coverage. This can be a slow process at times, and it’s where we are currently at with OBH programs.

Intensive outpatient care and partial hospitalization care were some of the first major mental health services to be recognized and reimbursed by insurance companies. Both of these levels of care offer intensive mental health treatment for a number of hours a week, but release patients back home for sleep, school, and other daily activities.

One of the next treatment services to receive recognition and coverage by insurance companies were residential treatment centers. These facilities offer longer term intermediate care for patients suffering from chronic mental health issues. The passage of the 2008 Mental Health Parity and Addictions Equity Act also played a role in health insurance carriers beginning to offer coverage for residential treatment facilities.

Currently, OBH programs and healthcare advocacy firms are working with insurance companies to collect the necessary information for OBH programs to be recognized and clearly established as authorized for coverage. There is overwhelming evidence from mental health professionals and researchers showing that OBH programs are beneficial (particularly for adolescents and young adults). Through the ongoing hard work and dedication from researchers, OBH providers, healthcare advocates, and attorneys, OBH care and insurance providers are slowly gaining traction and more and more families are receiving insurance reimbursement support.

Insurance Claims and Billing

A notable step forward for OBH care was The American Hospital Association’s recognition of OBH care as a viable form of treatment, and the National Uniform Billing Committee’s establishment of an insurance billing code for OBH care in July 2016. This update, and the corresponding change to the UB-04 billing manual, show that OBH care has been recognized by both the general medical community and federal organizations as a valid treatment modality.

With this valuable step, several healthcare advocacy firms have helped implement the new revenue code (“Outdoor/Wilderness Behavioral Healthcare, Revenue Code: 1006”). One such healthcare advocacy firm, Denials Management, Inc., reports that they have obtained over seven million dollars in reimbursements for families of wilderness patients between 2014 and 2018. They anticipate this amount to rise as the updated revenue code continues to pave the way for widespread recognition of OBH care.

Scientific Research

Historically insurance providers have denied OBH treatment claims classifying it as “dangerous,” “experimental,” or “unproven”. However, nothing could be further from the truth. Today’s OBH Accredited programs offer a safe and secure treatment modality for adolescents and young adults. The Outdoor Behavioral Health Council (OBH Council) was founded in 1996 to advance the field through establishing best practices with effective treatment and using evidence-based research. Through this research the OBH Council has been able to work with insurance companies and provide the necessary evidence showing how OBH Council programs are safe and effective.

The research conducted through the OBH Council and other independent researchers all point to the same conclusion—OBH Council programs are a highly effective treatment modality for teens and young adults. In fact, since 2012, over 40 independent, peer reviewed studies have come to the same conclusions—that OBH care from an OBH Council program is effective. In fact, many of these studies show OBH Council programs are more effective than other forms of intensive treatment, while costing less for patients! A recent study concluded that care from an OBH Council program was up to three times more effective than treatment as usual for mental health and substance abuse patients. Not only are OBH Council programs more effective, the treatment completion rate for OBH Council program patients is higher than that of patients in other levels of care. Treatment completion is a key indicator of positive outcomes, and OBH Council programs have a 93% completion rate compared to 42% for treatment as usual. All of these proven benefits occur while costing less money than alternative forms of treatment. These cost savings alone are significant: OBH Council programs are (on average) $8000 less expensive while being 2.75 times more effective than treatment as usual. It’s with these types of results and ongoing research that the OBH Council continues to stride in its collaborative efforts with insurance companies in providing more effective, and affordable mental health services to their clients.

Legal Action

During this process of recognition by insurance companies some families have needed to take more immediate steps to address their current financial struggles. This has resulted in legal actions. There have been several recent decisions concerning whether or not a health insurer’s decision to deny OBH care violates the terms of the Mental Health Parity and Addictions Equity Act (MHPAEA). In many of these cases, federal judges have found that an insurer’s action to blanketly exclude OBH care from coverage, while having no similar limitation on intermediate medical/surgical care, appears to violate the MHPAEA’s requirement that mental healthcare and medical care be treated similarly.

One such case was a class action suit brought against Regence Blue Cross and Cambia Health Solutions, which resulted in these insurers offering a settlement. Several other cases are being argued individually and are still pending judgment, which will further outline the legal responsibilities of insurers in regard to OBH care. Other cases that were decided in favor of OBH programs include:

• Michael D. v. Anthem Health Plans of KY., Inc
• Z. v. Regence BlueShield
• Vorpahl v. Harvard Pilgrim Health Insurance Co.
• H. v. Microsoft Welfare Plan • Buchanan v. Magellan Health, Inc.

There are several other lawsuits currently pending in district courts nationwide that involve insurance coverage of OBH programs. We will keep an eye on these cases, and update this blog periodically when more information becomes available.

What does this mean for you?

There are many OBH programs out there, but few belong to the OBH Council due to the rigorous requirements of ongoing research and accreditation that indicates a commitment to the highest treatment standards of the field. If you are considering placing your child in an OBH program, it is highly recommended you consider a program that is an accredited OBH Council program. The OBH Council has over 15 years of risk management research showing adolescents in an OBH Council program are two times less likely to visit an ER or doctor than an adolescent at home. It’s for all of these reasons families should seriously consider an accredited OBH Council program.

If you are considering placing, or have already placed your child in an OBH program and are seeking insurance reimbursement, consider hiring a healthcare advocate to help you navigate the complexities of insurance reimbursement. Some OBH programs provide recommendations or healthcare advocates can be found through online searching. Some healthcare advocacy firms charge based on a percentage of the money obtained from your insurance company, while others charge a flat rate. Either way, healthcare advocacy firms can be highly beneficial in determining if you are eligible for insurance reimbursement, and then working with you through the claim’s procedure.

Working with insurance companies for reimbursement for OBH care can be a disheartening process, but you are not alone. Your child’s program, the OBH Council, dedicated healthcare

advocates, attorneys, and parity advocates are there to help. One of these advocacy groups is the Kennedy Forum. This group focuses on fully implementing the parity law and working with insurance providers to guarantee equal access to mental health care. I encourage all to consider getting involved and contact a group like the Kennedy Forum and see what you can do to help.

We are seeing changes in insurance coverage for OBH programs, and there is still more work to be done. With the dedication of all those involved, we truly believe it’s not if, but when insurance companies recognize the high effectiveness of OBH programs and the value saved, they will provide full coverage for them as any other intermediate mental healthcare treatment.

Written by the OBH Council Chair

With special thanks to Dr. Michael Gass from the Outdoor Behavioral Healthcare Research Center for the research information outlined in this blog and Denials Management for the overturned information included in this blog.

A recent article in The Atlantic characterizes the wilderness therapy industry in a negative light. The article is sensational and inaccurate about the form of treatment known as adolescent wilderness therapy. Christie Woodfin has written a response to the article, which highlights the many positive outcomes of taking part in a wilderness therapy program.

OBH Council works to advance the field through best practices, effective treatment, and evidence-based research.

By Christie Theriot Woodfin, M.Ed., L.P.C.

When parents approach educational consultants for guidance regarding their struggling adolescents, one option they are exposed to is wilderness treatment. It sounds counter-intuitive that sending a child away from home will bring a family closer together. And it seems punitive rather than curative to place a student in a forested area and teach him to be a creator of his environment rather than someone who feels provided for, shaped and controlled by others. But research and our personal experience have shown this approach to be a valuable first step in moving youngsters towards stronger mental health and personal responsibility.

Wilderness programs have grown up over the last several decades to address the needs of youngsters who are suffering from a variety of emotional difficulties during the tough passage from childhood to adulthood. Unlike earlier types of these programs, good wilderness programs are positive, relationship based programs which are clinically sophisticated, Unlike boot camps which attempt to break one’s spirit, wilderness programs have as their aim encouraging young people in identifying their own strengths, developing pro-social behaviors, and realizing their own power to change their lives. Since blaming others is a typical adolescent behavior, this latter characteristic of wilderness is a particularly valuable lesson, and nature is a particularly consistent teacher.

The salutary effects of being in the woods have deep roots in our culture. We have evidence from our earliest Biblical traditions, from Native American culture, more recently from Boy Scouts and the team building experiences of Outward Bound and NOLS, of the benefits of leaving the comforts of home and experiencing nature. In Hebrew tradition, Jacob wrestled with The Unnameable in the dessert. In New Testament, Jesus spent 40 days in the wilderness for the purpose of examining himself and his purpose in life (and in so doing confronting his own temptations). Current research is highlighting the need for regular sleep patterns, aerobic exercise, and healthy diet as baseline behaviors for addressing depression, anxiety, mood dis-regulation, and a host of other mental health issues. With electronics exacerbating the problems our young people are having with connecting interpersonally and living a healthy lifestyle, the efficacy of being in nature is increased all the more.

Being away from the distractions of home and the aforementioned electronics, substances, negative peers or even isolating behaviors is helpful in providing a space for contemplation. Being in the splendor of nature provides its own level of magic, and tends to trigger existential thoughts in the process. Caring field staff and highly trained, MA or PhD level, therapists, help interpret every physical obstacle into a metaphor of life for students who have habitually given up, manipulated or avoided challenges that they have faced and will face in the future.

Longer term therapeutic boarding schools — the vast majority of which have no fiduciary relationship with the wilderness programs — often request that a youngster attend wilderness prior to enrollment because they arrive with a sense of responsibility, a lifted mood, a positive attitude about themselves and a readiness to further explore themselves and improve their lives.

Sometimes, when a student is resistant to change and defiant to his parents, parents choose to hire a transport service to bring the student to the wilderness program. The two-person teams that take adolescents from home to program are highly trained in de-escalation techniques, so they work hard to align with the student and get him or her to their destination in the more pleasant and cooperative way that teens usually treat people who are not their own parents.

As for the safety of wilderness programs, these programs are regulated by their respective states with few exceptions. They are careful about safety issues from performing background checks on field staff, requiring that no one staff ever be alone with a student, keeping track of how much each child is hydrating daily, having medical emergency response training, as well as being adept in working with youngsters. Some have physicians who go out into the field. The programs outfit students completely in gear that is appropriate for the climate and the activities they will be engaging in. Storing the students’ incoming clothing also assures that they will not be smuggling substances into the camp site with them. Statistics on teen mortality are far higher for teens’ accidental vehicular deaths, drug over doses, suicide, football, biking and skate-board injuries – the injuries they incur at home – than for wilderness related injuries. The University of New Hampshire has done extensive research on this aspect of wilderness therapy.

Educational consultants, who act as advisors to parents, visit the programs frequently, and speak with the therapist weekly when we have one of our clients enrolled. We are careful about placing each client in a program and with a therapist that is appropriate for their particular need, whether it is a grief issue, a struggle with understanding his adoption or his parents divorce, school anxiety, depression, promiscuity or substance abuse.

Parents choose to send their students to wilderness programs when they have exhausted their local resources and outpatient therapy hasn’t worked. They are feeling ineffectual in reining in their child or in pulling her out of her depression or isolation. They see the gap between their child’s development of that of her peers widening, They choose this option as the next step on the road to restoring their teenager to wholeness. Although there are occasional stories of a placement that did not go well, or an injury that has occurred, the plural of anecdote does not make data. It is our experience that an overwhelming majority of students emerge from wilderness feeling healthy and better equipped to deal with the challenges of adolescent life.

Contact Information

Christie Theriot Woodfin, M.Ed., L.P.C., Certified Educational Planner
Woodfin & Associates, LLC
404-249-9898
cwoodfin@bestschoolforyou.com
www.bestschoolforyou.com