Coming to the realization that you may need treatment for an alcohol or drug dependency can be very daunting. From coming to terms with an addiction, to choosing the right treatment center and figuring out how you will pay for it can be overwhelming to say the least. Fortunately, unlike in the past, nearly all insurance plans cover at least a portion of your rehab stay today!
How do I know if I need treatment for addiction?
Substance Use Disorders (SUDs) are a group of chronic, progressive illnesses that affect nearly every aspect of the sufferer’s life. SUDs are considered brain and behavior disorders, meaning the use of drugs changes an individual’s brain reward system. This change in the way your brain functions will lead to behavior changes in an individual that will cause them to seek more drugs in an effort to gain those rewards. This creates a vicious cycle where more drugs lead to more changes in your brain’s functionality, which leads to seeking more drugs, and so on and so forth.
Examples of substances that can cause Use Disorders are Alcohol, Opioids, Sedatives, Methamphetamine, Benzodiazepines, Cannabis, and other synthetic and prescription drugs. Luckily, there is treatment for alcoholism and addiction, and people can recover and live happy and useful lives after experiencing SUDs. However, just like any other medical treatment (surgery, physical therapy, going to the ER, giving birth, etc.), getting treatment for alcoholism and addiction can be expensive. Fortunately, there are several different ways to help pay for life saving addiction treatment, with the most common being using your health insurance.
How do I know if my insurance plan will cover a stay at an addiction treatment facility?
Depending on your health insurance plan you might be covered for Mental Health and Substance Abuse benefits. And thanks to Mental Health Parity laws, seeking treatment for mental illnesses like addiction shouldn’t cost more than similar medical treatments. It probably will cost something though. Most health insurance plans require payment of some sort from their plan members, including deductibles, copays, and coinsurance.
A deductible is the amount an individual or family will need to pay toward medical treatment before any health insurance benefits kick in. Copays are usually flat rates that an insurance company requires a member to pay for office visits, urgent care, or seeing a PCP. Copays can be charged before and after the deductible is met. Coinsurance is the amount both the insurance and the member pay toward the contracted rate of a health provider. Coinsurance for the member usually varies between 10%-30%. For instance, say a provider is in network with an insurance company to provide a service and the contracted rate is $100. If the coinsurance of the member is 80%/20% then the member would pay $20 for the service while the insurance would be billed for the remaining $80. Coinsurance is usually applied after the deductible has been met. Unless an individual’s insurance plan covers 100% of all costs, or an individual or family have met their maximum out of pocket for the year, there will be some cost for treatment even if that individual is using their health insurance.
When an individual wants to use their health insurance to help pay for substance use treatment the process usually involves receiving prior authorization, performing utilization reviews, medical necessity, and case management. “Prior authorization” is a step in the managed care process that basically means the hospital, doctor, or treatment facility has to get permission from the insurance company before giving treatment. A clinician or other representative from the agency will communicate the circumstances and presenting problem of the member to their insurance carrier. The insurance company will then either approve or deny the requested level of care based on “medical necessity”. Medical necessity means that the insurance company has to agree that the requested treatment or level of care is medically needed for that person and that the person couldn’t get the same benefits of treatment at a lower level of care.
There are different levels of care for substance abuse treatment that vary with duration and intensity. The most common levels of care are Inpatient Detoxification (or Withdrawal Management), Residential treatment, Partial Hospitalization, and Intensive Outpatient. During the course of treatment, the provider is regularly communicating with the insurance company the current prognosis and progress of the patient. This includes advocating on the patient’s behalf to receive the maximum amount of insurance benefits they are due.
Using health insurance can help ease the cost of treatment, but it very rarely covers 100% of all services. While involving a third party in the health care decisions between a patient and a provider can be frustrating and ineffective at times, the out-of-pocket costs to the patient can be lower than paying for treatment without insurance. Weighing the pros and cons of whether to involve a third party in healthcare decisions should be done with one’s family or support system before treatment is initiated. Let your mental healthcare provider know before treatment that you have health insurance and would like to use those benefits.
What type of insurance is best when considering mental health and addiction struggles?
The three primary types of insurance for mental health and addiction treatment are Public, Private, and Group policies, with each one working a little differently.
Public Insurance policies are either State or Federal Government funded programs to help make treatment more affordable. Unfortunately, there are very specific income requirements to be eligible for these policies, and not all treatment centers are subsidized by the government which means that they can’t accept these types of policies.
Private Insurance policies are not government funded, but rather purchased from the insurance carrier or provide by the individuals employer. This type of policy is often more expensive than others, but in turn provides more ‘perks’. Private insurance policies will usually include less out-of-pocket expense for addiction treatment, many more options in treatment facilities, more likelihood of covering inpatient treatment, and coverage for Holistic treatment.
Group Insurance policies are employer-provided benefits that usually provide for addiction treatment. However, some individuals may balk at using this type of policy out of fear that their boss and co-workers may find out about their addiction struggles. Luckily, most companies have rules in place to prevent one’s medical information to get out. Group polices will likely cover outpatient support, detox, and long-term inpatient care.
How can I begin my journey to end my addiction and enjoy the freedom of sobriety?
Regardless of what type of insurance you have, the best way to get started is to contact the rehab facility of your choice and ask them for help. At Bay Area Recovery Center, we have trained staff to help you navigate the costs of your treatment. With decades of experience behind us, we offer individualized treatment programs that target the root causes of your addiction. We offer competitive pricing and can work with most clients regardless of insurance type or self-pay status. Contact us today to get started on your journey to a sober life.