People suffering with addiction often do not seek help because they think that they cannot afford it. Family members of those suffering with addiction often worry about how they will be able to pay for treatment or how they can help financially. One of the best ways to pay to for treatment is using your insurance. Most private and public health insurance firms typically cover at least a portion of residential inpatient treatment and outpatient treatment programs. They recognize the damage drugs can have on all aspects of a person’s life and know that with rehabilitation it is treatable. They see treatment as a precautionary medical concern. Some companies do have certain terms for patients using this insurance to ensure the patient does fully recover. When someone’s insurance doesn’t cover addiction treatment public insurance may make it more affordable. There are specific guidelines for these plans so it is important to make sure the public insurance will work for you and cover treatment costs. Private insurance is more expensive than public insurance but it also allows you more options and benefits. Private insurance companies can be paid for by the individual or an employer but isn’t subsidized by the federal government or any of its agencies. Under the Affordable Health Care Act, an insurance applicant is no longer penalized for a pre-existing condition, allowing someone who is already battling addiction to apply for a healthcare policy. Drug and alcohol disorders are included in the ten essential health benefits central to the ACA, which means that these policies must treat addiction and mental health disorders with the same level of importance as any other medical condition. The Mental Health Parity and Addiction Equity Act of 2008 mandates health insurance companies to balance the drug and alcohol treatment program for group plans to the stipulation for standard medical rehab when addicts fear losing their job. These plans will usually cover plans for detox, individual and group outpatient support, residential hospitalization, and long-term inpatient treatment.
Will Your Insurance Cover?
The easiest way to find out if your insurance will cover treatment. or what exactly they will cover, is to call them with your policy number and clarify your policy coverage with them. You can also check the National Alliance for Model State Drug Laws (NAMSDL) website to find your state’s lead agency for administering addiction treatment services and clarify which laws and policies are available to you in your state. Calling a third party association, such as Addiction Treatment Association, who can aide you in finding a health insurer that provides clear and affordable coverage for addiction treatment. When you do call your insurer there are certain questions you should ask to make sure that you understand your plan and coverage.
What to Ask
- Does my plan provide coverage for treatment of drug abuse? They will be able to tell you what benefits you have or inform you that drug rehab is handled by a “managed behavioral health organization (MBHO).” If so, your insurer should let you know the name of the company and how to contact them. Then you will deal with the MBHO, instead of your insurer.
- Do I need a referral from my doctor? Sometimes, benefits can be reduced or denied if you don’t get required referrals.
- Is my diagnosis covered? Your insurer will consider whether they believe your condition is “medically necessary.” Plans might not cover repeat care if you didn’t follow through with your last course of treatment. They may cover care, but not to the extent you would like. In addition, your insurer will consider if there is any reason that your treatment would fall under a general exclusion of the plan. Another exclusion may apply if your treatment was court-ordered.
- What type of plan do I have? Preferred provider organizations (PPO), you can choose a covered provider (as long as they meet the plan’s definition of a covered provider). However, you get a greater benefit if you go to “in-network” providers, rather than “out-of-network” providers. Managed care plan, you must go to an in-network provider to receive coverage. Consumer-driven health plan, these are usually a PPO hybrid, and have very large deductibles (thousands of dollars). Usually once the deductible is met, all covered services are paid at 100 percent.
- Is there a difference in coverage between in-network and out-of-network care and if so, what is it?: It’s common for plans to pay a higher benefit for in-network care.
- Is there a deductible? The deductible is the yearly amount you must pay before the plan will start paying benefits. In some instances, the deductible is waived, like for preventive care or sometimes for inpatient care.
- Will there be copayments? Copayments are like mini-deductibles. They apply to individual services, like office visits, prescription drugs, and they usually do not apply toward your deductible. It’s important to understand how much your copayments are and what they apply to.
- What is my out-of-pocket (coinsurance) limit? If you pay a percentage toward your medical services, like 30 percent after 70 percent coverage, those amounts you pay go toward your yearly out-of-pocket limit. Once that limit is met, your remaining covered health expenses for the year are paid at 100 percent. If your rehabilitation is covered, your insurer will pay the provider directly, but you will be billed for out-of-pocket expenses.
- Are there any restrictions on where I can get help? Besides considering “in-network” providers, your plan will likely only cover certain drug rehab facilities. You’ll want to ensure you find out up front, so that you can choose the most effective, and affordable drug rehab center.
How We Can Help
The cost of treatment is always a worrisome topic when people are thinking about getting treatment, but can you really put a price on saving your life or the life of your loved one? Recovery Ways admissions coordinators will work with your insurance to determine your coverage and benefits prior to admission. We do all the work so that the patient can focus on getting sober and healthy. For more information regarding coverage and your benefits and cost, call us toll free 24 hours a day at 1-888-986-7848.
