Addiction Treatment, Insurance & Levels of Care
Most drug & alcohol rehabs have five levels of care either on site or nearby that they are affiliated with such as a detox. Unless you self pay, levels of care are not determined by your treatment center but rather by your insurance company. Finding the right treatment center able to work with your insurance can be the difference between the right level of care, a couple of weeks in treatment or several months. Below you will find each level of care explained and can see that depending on your insurance company or ability to self pay for treatment that it is possible to enter a long term care treatment facility for several months rather than just the traditional 30 days. Having an independent review of your insurance benefits can be the difference between the right treatment center or the wrong treatment center.
- Detox – This is the first level of care for almost everybody coming into treatment. At this level you should be medically supervised and monitored while tapering down medically from which ever drugs or alcohol you were using. Most insurance companies cover this part, however we are seeing more and more providers such as Blue Cross Blue Shield deny this level of care. It is not uncommon for us to have to tell someone or their family that all other levels of care are covered except for detox. This can leave a family having to cash pay or find a finite in network detox facility. It is important to understand your policy and we can help with that.
- Alcohol & Benzodiazepines Detox – These are the most dangerous of all substances to detox from and require medical supervision. Many people detoxing from the two drugs can have seizures or convulsions. All detoxes are dangerous, however of them all, these two have the highest risk of death if not done medically and properly. If you know of anyone trying to detox from either alcohol or benzodiazepines alone, please dial 911.
- Opiate Detox – People detoxing from opiates such as heroin or pain killers feel like they are going to die because of the physical symptoms associated with opioid withdrawal. Unlike years past, today, almost all opiate detoxes are done with a Suboxone or Subutex taper. Because these medications are so effective at keeping you comfortable, it is not uncommon for some detoxes be on an outpatient basis with little to no withdrawal symptoms at all.
- Stimulant Detox such as Cocaine, Crack, Crystal Meth & Adderall – In most cases the withdrawal of the substance is the opposite of its effect or high. So for many detoxing from stimulants, the person sleeps for countless hours at a time only getting up to use the restroom or eat. Please keep in mind that all detoxes are dangerous, however it is often the case that people coming off of theses drugs go through the least amount of physical pain or symptoms.
- Residential (RTC) – This is the level of care for many right from detox. Most people are unaware that insurance companies cover on average only about 9-10 days of RTC. We are seeing more and more insurance companies deny this level of care or have heavy stipulations such as requiring a nationally accredited treatment center in order for claims to be approved. We are seeing more and more treatment centers do away with this level of care because of insurance companies unwillingness to pay or approve claims.
- Partial Hospitalization (PHP) – Is the level of care most often used and approved by insurance companies. The old days of PHP were basically hospital type day programs which had you in treatment from 8-5 Monday through Friday near where you lived. Today, most treatment centers are able to keep you in an extended care facility which is like a residential type setting for longer periods of time at the PHP level of care. Unlike RTC that has an average approval of about 9-10 days, it is not uncommon for your insurance company to approve 20-30 days of care at this level.
- Intensive Outpatient (IOP) – At this level of care you can expect to attend three meetings a week with your counselor in a group setting for 3-4 hours a session and occasionally a one on one meeting. This level of care is the most important for an extended care facility because this is the level of care that can be the difference between being in treatment 30 days or 4-6 months. Depending on the type of insurance company you have, many times we have seen 30 – 45 days of IOP approved which increases the time you stay at an extended care facility.
- Outpatient (OP) – This is the lowest level of care for any treatment center, and is most likely the level of care you will continue on with in your aftercare. However, depending on your insurance carrier and the amount they approve, we have seen people stay in extended care facilities for an extra month or so at this level. The most effective solutions we have seen is when a discharge is made to a half way house or sober living house while outpatient classes are continued.
This section of our website was designed to help people understand the complexity of insurance companies and treatment centers. Most people assume their insurance is good because they have good health benefits which is almost never the case. There are so many options to consider in choosing the right place especially your insurance coverage, levels of care you will receive, how long you can stay and where the center is located. At Addiction Treatment Services this is what we do, we verify you insurance, explain your options and help you get to the best place. We tell you what you insurance company doesn’t. It isn’t that they won’t tell you either, it’s that they don’t know themselves. Many people see their coverage on paper at 80%, 90%, 100% coverage etc and then speak with a customer service rep who has no ability to discuss anything other than their benefits, leaving the insured person thinking they know everything and how it works. Sadly, this is absolutely not how it works. Treatment centers accept insurance based on historical data as to whether or not a claim will be approved or denied. Not even your own insurance company can tell you if claims will be approved or denied. The bottom line is, if you have seen one insurance policy, you have seen one and until it is verified you just don’t know what will be covered.