Insurance Coverage for Addiction Treatment
Substance use disorders (SUDs), are very serious and can affect a lot of people. Unfortunately, many people that need addiction treatment that wonder does insurance cover rehab may avoid getting help because of the cost. What these people may not realize though is that getting insurance to cover treatment costs is becoming much easier. In the past, it was common for people to pay for rehab without insurance. Then a law was passed in 2010 that changed things.
The Affordable Care Act
The Affordable Care Act (ACA) mandates health insurance companies to provide just as much coverage for mental health and addiction treatment. Due to these changes, insurance companies that don’t participate in the ACA marketplace also now frequently offer treatment for addiction. Thus, when asking does insurance cover rehab, the answer is usually now yes.
What is Insurance?
Simply put, insurance is a contract represented by a policy. In this contract, an individual or a presence (such as a company) receives financial protection or reimbursement for losses from the insurance company. If something bad happens to the person or thing that is insured, the insurance company that sold the insurance policy will pay the cost for what was lost or ruined back.
Does Insurance Cover Rehab?
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is a federal law. Its purpose is to prevent group health plans and health insurance companies that provide mental health or substance abuse coverage from putting limits on the benefits. Therefore, the answer to the question does insurance cover rehab is yes.
Insurance companies must provide mental and substance use disorder treatment coverage that’s equal to the medical/surgical benefits in their plans. In 2010, this law was amended by the ACA to include individual health insurance coverage as well.
Why is Addiction Treatment Important?
There are several reasons why treatment for this disease is important. They include:
Expenses
Substance abuse is an expensive problem. The National Institute on Drug Abuse (NIDA) stated that substance abuse costs more than $740 billion per year in healthcare costs, crime, and lost productivity.
Aside from the monetary expense, addiction coverage is an important benefit for other reasons. For one, it keeps people out of ambulances and emergency departments from overdoses. Plus, getting people into recovery helps them avoid going to jail. It also prevents other health problems that result from substance abuse.
Addiction and Mental Health
Substance abuse and mental health issues influence each other. Often, people with mental health problems will use substances as a way to self-medicate their mental health symptoms. People who are addicted to drugs might even develop mental health issues because of the chemical changes that drugs cause to the brain. As a result, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 8 million adults suffer from both mental disorders and SUDs.
Generational Spread
Children who spend time around adults who do drugs are more likely to abuse substances themselves. The effects of drug abuse can continue to be handed down through generations unless it is stopped. Thus, treating a parent’s SUD can prevent his children and grandchildren from developing substance addictions.
Does Insurance Cover Rehab? If So, What Features of Addiction are Usually Covered?
Treatment Settings
There are various settings where addiction treatment takes place.
- Outpatient–Doctor’s offices and clinics are considered outpatient care. This is because their patients usually don’t live at their facilities. Many insurance companies prefer outpatient settings because they tend to be less expensive.
- Inpatient or residential treatment – These forms of treatment require patients to live in rehab facilities while attending addiction treatment. As a result, inpatient and residential forms of addiction treatment are more intense and more expensive.
You will need to check with your health insurance company to see how much coverage you can receive for your specific type of addiction treatment program. This is because insurance companies don’t approve every facility, doctor, or program.
Types of Treatment
Medical or Non-medical Detox
Most addicts need to attend medical detox before attending addiction treatment. This means staying in a medically supervised detox facility until your body’s system cleans itself of drugs and toxins.
It’s important to note that withdrawal symptoms during detox can be extremely uncomfortable and dangerous. Therefore, it might be necessary for doctors to prescribe you withdrawal medications. Whether or not you need medication-assisted treatment and your length of time in detox will depend on the substance you used, how much you used, and the duration of your substance use.
Residential or Inpatient Treatment
At this care level, you live at the treatment facility that you’re receiving care at. This is so that you can stay in a structured, safe, and controlled environment with 24-hour supervision. Residential and inpatient treatment programs are necessary for people with severe substance use and/or mental health disorders.
Outpatient Treatment
Outpatient programs vary. For example, partial hospitalization programs, intensive outpatient programs, and standard outpatient programs are all forms of outpatient treatment. Regardless of the type, all outpatient programs allow patients to live at home and when not to receive classes and therapy sessions at treatment centers. The difference between the different types of outpatient treatment programs is in the amount of time it takes to complete the programs.
Dual Diagnosis Treatment
A dual diagnosis is a substance use disorder and a mental health disorder that occur within a person simultaneously. Dual diagnoses are very common. Due to the MHPAEA and the ACA, insurance companies are required to offer just as much coverage for mental health treatment as they do for medical treatment.
Aftercare
Individuals are much more successful in their long-term recovery if they attend aftercare treatment once their regular form of addiction treatment is over. Attending aftercare treatment means continuing therapy or counseling and participating in self-help groups while in recovery.
Maintenance Medication
Some addicts may need to continue using prescription withdrawal medications for to maintain long-term sobriety. That way addicts in recovery can manage their cravings and not relapse.
Important Insurance Terms You Should Know
If you plan to use health insurance to pay for addiction treatment, you should know some insurance terminology. Some common insurance terms you should know include:
Medical Necessity
Insurance companies use the standard of “medical necessity” to determine whether the treatment recommended by your medical provider is:
- reasonable
- necessary, and
- appropriate
If the company decides that the treatment is medically necessary, it will be covered.
Utilization Management
Utilization management is a process that companies use to decide if the treatment you request is not only medically necessary but in agreement with accepted medical practice. This way of monitoring treatment has proven to be effective in the past.
Prior Authorization
Some people call this pre-approval. You or your care provider must request approval for a service, treatment, or prescription drug before your health plan will cover it.
Step Therapy
Step therapy is comparable to prior authorization, but you must try a less expensive drug or service before you can move on to the more expensive prescription or service.
Denial and Appeal
If you are denied coverage, you may appeal the decision. Keep in mind that mental health parity is the equal treatment of SUDs, mental health conditions, and other health conditions under insurance plans. Most health plans are required to abide by federal and state parity laws.
In-Network and Out-of-Network
Frequently, insurance companies have special associations with certain care providers. These connections are the difference between in-network and out-of-network.
The difference has an effect on how much coverage your insurance company will give and how much you will have to pay. Providers who are in-network with your insurance company are the best choice when it comes to cost. If you aren’t sure, call your insurance company or treatment facility.
Different Types of Insurance Plans
- Exclusive Provider Organization (EPO)
This is a plan where insurance companies cover the cost of service if you use doctors, specialists, or hospitals in your insurance plan’s network. (except in an emergency)
- Health Maintenance Organization (HMO)
An HMO plan usually limits coverage to care provided by doctors who work for facilities that are within your insurance company’s network. It typically won’t cover out-of-network care except in an emergency. An HMO plan might also require you to live or work in the service area of your treatment center to qualify for coverage. HMOs often focus on prevention and wellness and provide integrated care.
- Point of Service (POS)
Point of Service plans are more flexible when it comes to providing out-of-network care than HMO plans. POS plans do require that patients get a referral from a primary care physician before seeing a specialist though.
- Preferred Provider Organization (PPO)
PPO plans allow you to receive healthcare at in-network and out-of-network facilities. You can even receive healthcare services from out-of-network facilities and physicians without a referral from your primary physician. It will still cost you more to receive out-of-network healthcare services than it would to receive in-network healthcare services though.
Rehab Without Insurance
If you want to pay for rehab without insurance, there are options. Some of these options include:
- Self-Pay–This is an option if you want to pay for rehab without insurance. In fact, many individuals that choose to self-pay would rather pay for rehab without involving their insurance companies. This is especially true for people with health insurance that won’t pay the cost of rehab in full.
- Personal Loan–You may be able to get a loan from your bank or use a credit card to pay for rehab without insurance. Occasionally, family members are also able and willing to loan their loved ones money for rehab.
- Healthcare Credit–There are special healthcare credit cards with deferred interest that you can use to help pay for rehab without insurance. CareCredit is one such card and you can apply at www.carecredit.com.
- Medicaid–Medicaid is a federal program for low-income individuals and families, the elderly, and pregnant women. Medicaid will provide coverage for mental health and SUDs rehab without insurance. You can apply for Medicaid by contacting your state Medicaid agency.
Addiction Treatment Coverage at Graceland Recovery
Whether you’re looking to pay for rehab without insurance or with insurance, you can receive care here at Grace Land Recovery. Graceland accepts all private insurance and we will be happy to work with you on financing your treatment here.
Contact us now if you have any questions about addiction rehab and ways to pay for it here at Grace Land Recovery. Our phone lines are available for you 24-hours a day and there are no questions that we won’t do our best to answer.