Director of Utilization Review Michelle Sweet loves knowing that her team helps patients get the financial support they need to enter treatment and get the full measure of care they need for long-term sobriety. And she likes removing patients’ concerns about the financial burden of treatment while they are changing their lives. Michelle leads a four-person staff that collaborates with insurance companies, initially getting approval for treatment then securing authorization for as many days as patients need for recovery. One UR staffer, a screening specialist, calls in all admitting cases to the insurance companies to confirm initial certification to start treatment. After admission, the other staff members follow assigned patients’ progress through treatment, talking with their insurance company representatives to get authorization for additional treatment.
Easy to Represent La Hacienda to Insurance Companies
While Michelle trained in and is licensed as a chemical dependency clinician, the business side of addiction treatment always attracted her. “I have always been interested in seeing that a patient gets the coverage they need. Relieved of worries about financial matters, they can focus on doing the program.” She says representing La Hacienda makes it easier to convince insurers of patient’s needs. “I know the work we are doing here is amazing, so it’s easy to justify that to the clinicians on the insurance side.” “Ethics and the La Hacienda mission is the heart of this facility. Working within those parameters, you get positive results.”
Collaborating with Insurance Reps is Effective
Developing collegial relationships with insurance company representatives also produces effective outcomes. “I love talking to clinicians on the insurance side and building relationships with them so we can collaborate for the greater good of this industry,” says Michelle. Those representatives–always clinicians or persons with master’s level licensure—“are like co-workers, even friends. I talk to them all day long. I know about their kids and their families and where they went on vacation.” “That is how you make utilization review work. You build relationships.”
Joined the La Hacienda Staff in 2014
A native New Mexican, Michelle holds a master’s degree in Clinical Mental Health Counseling from Texas A&M University at Corpus Christi. She is a Licensed Professional Counselor, a Licensed Chemical Dependency Counselor, and a Nationally Certified Counselor through the NBCC. She has worked in the mental health/substance abuse field since 2008. She joined the La Hacienda staff as a Continuing Care Specialist in 2014, then moved over to UR in 2015 and became Director in December 2020.
Lives on Family’s Historic Hill Country Ranch
Michelle resides with her husband and daughter on a ranch on the South Fork of the Guadalupe west of Hunt that has been in her family for more than a century. She grew up visiting her grandparents on the ranch and always wanted to live there. The property is now primarily used for hunting leases, but they also raise Nigerian dwarf goats. Floating on the Guadalupe River and dancing the night away at Crider’s Dancehall are her favorite free-time activities. A collegiate soccer player, she continues involvement in the sport through an indoor league in Kerrville and coaching her daughter’s youth soccer team.
