Admissions at Promises Dallas-Fort Worth

Promises Dallas-Fort Worth admits people through a phone call, a benefits check and a clinical assessment. The campus is at 400 Highland Drive in Lewisville, Texas, and its own page describes it as a calm residential treatment setting for adults receiving addiction and mental health care [7].

Its page lists these levels of care: medical detox, residential rehab for substance use, residential mental health rehab, a virtual intensive outpatient program and aftercare planning [11]. One of those is unusual enough to say twice. The intensive outpatient card is marked virtual, and the campus’s own what-to-expect page limits it to Texas residents [7].

The campus takes people for primary substance use treatment or for primary mental health treatment, and it serves the greater Dallas-Fort Worth area from Lewisville [11].

Below, each step of admission is set out in sequence, from the screening conversation through to the questions that only come up once someone is on site.

What Happens on the First Call

Promises publishes its own answer to this, which is rare, so start there.

Its admissions page says the people who pick up are Recovery Advocates. They answer questions about treatment, help confirm benefits coverage, and run a pre-assessment to decide eligibility [8]. The questions they may ask are listed: your current living situation, substance use history, medical history, mental health history, family history of addiction, and your health insurance plan [8].

After that comes a recommendation. The campus says that once your insurance is verified, an advocate provides a treatment program recommendation tailored to your recovery needs, helps you settle on an admission date, and can assist with travel arrangements if necessary [8].

Be exact about amounts. Clinicians build a withdrawal plan out of those figures, and rounding them down is the only thing said on that call that can rebound medically.

Nor does the patient have to be the one dialing. Partners, parents and clinicians do it constantly for a person who is not ready. There are limits on what staff can say back, covered lower down. For the general shape, see our guides to how to get into rehab and what the rehab process is like.

The Clinical Assessment and How the Level of Care Is Decided

A clinical judgment sets the level of care, and it is made against published criteria.

SAMHSA’s consensus panel defines detoxification as a broad process with three essential components that may take place concurrently or as a series of steps [1]. The second of the three is the one people picture. Stabilization is described as the medical and psychosocial processes of assisting the patient through acute intoxication and withdrawal to the attainment of a medically stable, fully supported, substance-free state [1].

Matching a person to a setting is its own discipline. TIP 45’s placement chapter sets out the treatment settings and the five adult detoxification levels the field uses [2]. It explains that the American Society of Addiction Medicine built its Patient Placement Criteria as a consensus-based clinical tool for matching patients to the appropriate setting and level of care [2]. The same chapter says concern for safety is of primary importance. It adds that the final decision regarding placement always rests with the treating physician [2].

That is why nobody quotes you a level of care before the assessment.

Medical risk is what pushes the answer one way or the other, and it is not the same risk for every substance. TIP 45 lists seizures and delirium tremens among outcomes in severe alcohol dependence that can lead to fatal consequences [3]. It adds that for alcohol, sedative-hypnotic and opioid withdrawal syndromes, hospitalization or some form of 24-hour medical care is generally the preferred setting [3]. Opioids invert the timing: MedlinePlus states that withdrawal reduces tolerance, so those who have just gone through withdrawal can overdose on a much smaller dose [4].

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.

The campus says its treatment is based on each patient’s clinical needs, progress and insurance coverage [7]. It offers medication-assisted treatment when clinically appropriate, with each patient evaluated individually and the treatment team deciding whether it belongs in the plan [7]. Our explainer on levels of care covers the five treatment levels in general terms, and the rehab intake process covers the paperwork.

Insurance, Verification and What It Costs in TX

The campus sets out four steps and puts verification first: insurance verification, assessment, treatment planning, admission [8]. It says that in many cases you can verify coverage and begin treatment within days [8].

On carriers, the campus says it is in network with most major insurance carriers including Aetna, Ambetter, Blue Cross Blue Shield, Cigna and United, and that it offers private pay options where someone has no insurance or limited coverage [11]. That is a general statement about the campus, not an answer about your policy, so the benefits check still has to run.

Then the part worth reading twice, because this campus publishes it and many do not.

Many health plans require out-of-pocket costs before benefits apply. Those may include deductibles, co-pays, coinsurance and maximum out-of-pocket expenses, and the campus files all of them under one heading: your Patient Responsibility [7]. Four things move the number: your benefits plan, how long you stay, which services you receive, and services the facility offers that your insurer does not cover [7].

The campus is equally direct about whose job the checking is. It says it is your responsibility to check with your insurance provider before admission, that your plan may not be a participating provider with Promises Dallas-Fort Worth, and that you are responsible for all non-covered and out-of-pocket costs related to your stay [7]. Ask about that on the first call rather than after discharge.

Whatever the campus says, federal rules set a floor beneath a commercial policy, and there are two of them. The first is the essential health benefit rule: a Marketplace plan has to include substance use disorder treatment, may not refuse enrollment over a pre-existing condition, and may not cap that benefit in dollars annually or for a lifetime [5].

The second is parity. Under the Mental Health Parity and Addiction Equity Act, a plan that covers mental health and substance use care may not apply harsher limits to it than it applies to medical and surgical care, and that reaches prior authorization and step therapy as well as visit and day caps [6]. The scope is worth knowing: it applies to non-federal governmental plans with more than 50 employees, to group health plans of private employers with more than 50 employees, and to the individual market [6]. Plans from small employers are not covered directly; they get comparable protection through the Affordable Care Act’s essential health benefits requirement.

Two of our own guides sit alongside this one: insurance coverage for rehab and what rehab costs. The cost page opens with our published price ranges by level of care, then lists what changes the price, with program length first. It does not check your benefits for you. That is a call to admissions, and at this campus it is the first of the four steps above.

What to Bring and What to Leave at Home

Two suitcases. Storage is limited, and the campus asks you to read its full packing list before you travel [7].

Three cards matter more than anything else in the bag: a picture ID, an insurance card, and a prescription or pharmacy benefits card [7]. On money, avoid large amounts of cash. Prepaid debit cards are preferred, and the campus suggests telling your bank you will be away from home [7].

Medications come with you and then stop being yours to manage. Everything must arrive in its original, labeled prescription bottle, and the nursing department secures it [7]. Your physician decides what you take during treatment, and the campus says plainly that it may not include everything you were taking before admission [7]. That sentence surprises people, so raise any medication you are worried about on the call. If medication for opioid use disorder is part of your care, our page on medication-assisted treatment explains how it fits into a plan.

Toiletries have a rulebook of their own. Anything with a cord, plus razors and tweezers, goes into locked storage and gets signed out from staff [7]. Glass, personal mirrors and mirrored compacts are refused at the door, as is any product with alcohol among its first five ingredients [7].

Nicotine needs planning ahead. Cigarettes must be new and unopened in original packaging, and vapes must be disposable and non-rechargeable [7]. Staff run a store run for necessities and tobacco once per week only [7]. Staff cannot buy tobacco for patients under 21, so the campus tells people aged 18 to 20 who use permitted tobacco products to plan accordingly before admission [7].

Leave the linens. The facility provides linens, pillows and towels, laundry machines are available, and it supplies Free & Gentle laundry detergent [7].

Getting Here: Travel, Arrival and Who Can Come With You

The campus says it does not pay for travel to or from the facility, and that its representatives can help coordinate travel arrangements [11]. Its admissions team also says it can assist with making travel arrangements if necessary once an admission date is set [8].

Arrival is an assessment, not a check-in desk. The campus says staff perform a comprehensive intake assessment of your physical and mental health to build the treatment plan, and it lists what that may include: drug and alcohol screenings, physical exams, evaluations for co-occurring disorders, medical assessments and risk assessments [8]. Its own page says that in many cases treatment begins within 24 to 48 hours of the admissions conversation [8].

Then the sentence a family needs before anyone plans a trip. Promises Dallas-Fort Worth does not currently offer in-person visitation [7]. Its own Promises DFW site adds that virtual family sessions can be arranged by phone or Microsoft Teams with your primary therapist [12]. Belongings still move: family and friends may drop off necessary items such as clothing or unopened permitted cigarettes during designated times, and the campus asks you to confirm those times in advance [7]. A staff member receives them on arrival, and the campus states that a drop-off does not include an opportunity to visit the patient [7]. The campus’s what to expect page on this site covers daily life rather than the admission.

The First 24 Hours on the Lewisville Campus

The building is built for adults in residential care and not much else, which is why it reads as calm.

It is a mixed-gender facility with gender-specific housing, it accommodates up to 80 patients, and it has en-suite patient rooms, indoor recreation and fitness spaces, and an outdoor courtyard [7]. En-suite rooms typically hold two or three patients, XL beds are available, and ADA-accessible bathrooms include shower benches for patients who have difficulty ambulating [7].

Food is a large cafeteria staffed by a chef and two cooks who prepare meals for patients [7]. Special diets can be accommodated when approved by a physician or dietitian, and coffee, water, juices and snacks are available throughout the day [7]. Outside food and drink are not permitted [7].

The rest of the first day settles into a routine. Amenities include a large fitness center available Monday through Friday, yoga, art and expressive therapies, ping pong, cornhole, television, a small outdoor courtyard with a walking path, and optional virtual church services on Sunday mornings [7]. Which of those you see depends on your level of care, your clinical needs and the facility schedule [7].

Phones are the adjustment nobody plans for. Personal cell phones, smartwatches and other electronic devices are not permitted for patient use and are securely stored for the duration of treatment [7]. Facility landline phones are available daily from 5:30 p.m. to 10:00 p.m. CST, and the campus says there is no initial blackout period for landline access [7]. Personal computers are not permitted, though access to an onsite computer may be approved by the clinical team case by case [7]. Bring a written list of the numbers you will want.

For anyone whose withdrawal has to be supervised, medical detox is the opening stage, and it is the one with genuine medical risk in it. What comes after that is described generally on our inpatient rehab page.

Telling Work and Family

Two questions sit behind this one: what does an employer need, and what can anyone else learn?

Promises answers the first itself, and its advice is about timing. Its admissions page says that if you are considering using FMLA benefits to protect your job, it is really important to start the process as soon as possible, even before you arrive for treatment [8]. You will need to contact your employer to start the paperwork [8]. It adds a line worth repeating: to protect your privacy, you only need to say you are seeking medical treatment [8]. The entitlement underneath that is federal. The Family and Medical Leave Act lets eligible employees of a covered employer take job-protected, unpaid leave for up to a total of 12 workweeks in any 12 months [10].

The second question has a stronger answer than most people expect. Federal rules govern the confidentiality of substance use disorder patient records. Under them, the presence of an identified patient in a facility publicly identified as a place where only substance use disorder treatment is provided may be acknowledged only with the patient’s written consent, or under an authorizing court order [9]. A program answering an inquiry may not affirmatively reveal that an identified person has been or is being treated for a substance use disorder [9]. The campus puts the practical version on its own page. You fill out forms that only allow staff to discuss information with the people you designate, and it says no information will be disclosed to any party without your written, documented consent [8].

So pick your designated people during intake. That form, not a phone call later, is what decides who gets told anything.

If This Campus Is Not the Right Fit

An assessment that recommends somewhere else has not turned anyone down. It has done its job.

Usually one of three things is behind it. Clinically, the picture may fit a different setting — something an assessment determines and a website cannot. Financially, your insurer may decline to authorize this site, which is why the campus warns that your plan may not be a participating provider with it [7]. Practically, the journey may be impossible for the person or for whoever is driving.

Two published limits change the shape of a plan here, and both are worth raising early. Intensive outpatient treatment at this campus is virtual, and the what-to-expect page restricts it to Texas residents [7]. The same page says the campus does not currently offer an on-site partial hospitalization program [7]. If your picture of week four involved day treatment in Lewisville, put that to admissions on the first call.

Length of stay is published as well. The overall treatment stay averages approximately 21 to 28 days [7]. Stays of up to 30 days may occur on a case-by-case basis, depending on clinical needs and insurance coverage [7].

A recommendation for something lighter is explained on our outpatient rehab page. To see where else in the family a person might land, our treatment centers page starts from a clickable state map; a campus’s own site is where its programs are set out.

Wherever it lands, the same thing is true at the end. TIP 45’s consensus panel took special care to note that detoxification is not substance abuse treatment and rehabilitation [1], and most people need long-term treatment after detox [4]. Aftercare planning is a card on this campus’s page for that reason, and the work of it happens while someone is still here.

Frequently Asked Questions

Sources

1. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
2. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 2: Settings, Levels of Care, and Patient Placement. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64109/
3. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
4. MedlinePlus Medical Encyclopedia. Opiate and Opioid Withdrawal. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm
5. HealthCare.gov. Mental Health and Substance Abuse Health Coverage Options. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
6. Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
7. Promises Dallas-Fort Worth. What to Expect at Promises Dallas-Fort Worth. The Recovery Village. https://www.therecoveryvillage.com/facilities/what-to-expect-promises-dallas-fort-worth/
8. Promises Dallas-Fort Worth. Our Admissions Process. https://www.promisesdfw.com/admissions/
9. Legal Information Institute, Cornell Law School. 42 CFR § 2.13 — Confidentiality restrictions and safeguards. https://www.law.cornell.edu/cfr/text/42/2.13
10. Legal Information Institute, Cornell Law School. 29 CFR § 825.100 — The Family and Medical Leave Act. https://www.law.cornell.edu/cfr/text/29/825.100
11. Promises Dallas-Fort Worth. Promises Dallas-Fort Worth. The Recovery Village. https://www.therecoveryvillage.com/locations/promises-dallas-fort-worth/
12. Promises Dallas-Fort Worth. Residential Treatment: FAQs on family visits. https://www.promisesdfw.com/addiction-treatment-services/residential-treatment/

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village