Figuring out if your insurance covers drug and alcohol detox policy can be extremely difficult. You may not have the experience in health care policy to understand that giant booklet they handed you during benefit enrollment, but that’s OK. We do have experience in working with insurance companies, and can tell you what you need to know about getting your detox services covered.
Detox Services as a Medical Necessity
While the law requires that substance abuse treatment services, including detox, must be covered by your health insurance, the extent of your coverage may vary. For example, insurance providers have a right to only pay for medical services that are deemed necessary. Proving a treatment is necessary can be easier said than done, in some cases. You must be able to prove that you need detox services by providing a doctor’s note.
Here comes the next sticking point in negotiations. There are two kinds of detox services: inpatient and outpatient. While both are viable options, inpatient services are generally supervised more closely and have fewer instances of relapse. For that reason, inpatient treatment is also more expensive. Your insurance company may only pay for an outpatient detox, unless you can prove that an inpatient care center is medically necessary.
Determining Medical Necessity
Insurance companies look at a few different things to determine medical necessity for inpatient drug and alcohol detox. First and foremost, insurance providers evaluate the severity of your withdrawal symptoms. For example, withdrawal from alcohol, especially when you’ve been drinking heavily over a period of years, can be deadly. In this case, medically supervised detox is vital.
Next, providers will assess the intensity of services you’re requesting, as well as your projected length of stay. Finally, they’ll consider your unique personal circumstances. Do you have co-existing conditions such as depression, anxiety or another mental disorder? Do you have a family history of substance abuse?
Remember, your medical necessity status is fluid. In other words, you may initially qualify for treatment, only to find that your insurance company may downgrade your services over time. For example, you may qualify for inpatient treatment for a few days during detox, but see your insurance update to cover outpatient treatment once your symptoms stabilize.
Fighting an Insurance Denial
Even if you receive an initial insurance denial, you may have other options. Each insurance request has the possibility of one or more appeals. In order to fight an insurance denial, you’ll need the help of your physician and other experts in the mental health field. If you can prove that your request is based on medical necessity, you may be successful in appealing a denial.
What If I Don’t Have Insurance?
If you don’t have insurance to cover alcohol and drug detox, or your provider refuses to pay, you still have options. Many treatment centers offer their services on a sliding scale, and you may qualify for public or nonprofit funding.
Lastly, you may be able to pay for your services on an affordable payment plan. Financial situation should never be a barrier to quality detox services and treatment. Remember, we’re here to help!
Choosing a Partner to Help
Detoxing and beginning your road to recovery is something you should never have to do alone. Our team of interventionists can help you or a loved one find a quality treatment center, answer your questions, address your concerns and help you live your best life!
For more information about the services we offer and for negotiating with insurance providers, please reach out to us.