Finding Best Treatment Options with Your Insurance - Addiction Treatment Services

Considerations for Health Insurance for Rehab Before Addiction Strikes

Considerations for Health Insurance for Rehab Before Addiction Strikes - ATS

Addiction is a pervasive and all-consuming disease. No one plans on becoming addicted or needing to use rehabilitation or detox services, yet thousands of Americans use these services each year.

No one plans on dying unexpectedly or incurring serious injuries, yet we purchase life insurance and disability insurance for protective purposes. This is exactly what our health insurance does for detox. It helps us pay for the unforeseen, which may include addiction treatment and detox services.

Addiction Treatment Is an ‘Essential Service’

The Obama administration passed the Patient Protection and Affordable Care Act (ACA) in 2010 – also referred to as “Obamacare.” The administration established a number of so-deemed “essential” medical services under this law. When a medical service is “essential,” insurers must pay for all or at least a portion of these costs.

One of the most groundbreaking aspects of this rule was making addiction treatment services essential. Previously, insurers often refused to pay for addiction treatment, using the justification that “you made your bed, now you get to lie in it.”

Fortunately, the provisions of the Affordable Care Act recognize addiction for what it actually is – a complex medical condition that affects victims physiologically as well as psychologically. In fact, the physiological addiction caused by some substances can be so strong that attempting to stop on your own can lead to dangerous consequences. Alcohol withdrawal, for example, can lead to debilitating or life-threatening seizures.

Is Rehab Covered by Insurance?

Addiction treatment services are essential, but people might wonder if they can still get health insurance for rehab. The simple answer is that any plan, regardless of its level, will offer some assistance with addiction treatment costs. The amount that your insurance company pays will depend on your level of coverage.

The Affordable Care Act recognizes that it’s unrealistic to expect anyone, especially those struggling with addiction, to pay thousands of dollars for rehabilitation costs. When shopping for health insurance, it’s a good idea to look at the percentage of rehabilitation costs your plan may cover.

Who Should Plan for Addiction Treatment?

Everyone should plan for the unforeseen, even if it doesn’t seem in the realm of possibility. It’s essential to understand that addiction can develop unexpectedly, even in an unexpectant individual. Say, for example, that you have a surgery or medical procedure that requires narcotic painkillers. An addiction to these potent substances can develop quickly, and even lead to heroin addiction.

In our scope of practice, we often run into individuals who are “surprised” by their or their loved one’s addiction. Having peace of mind that you have access to treatment for heroin addiction helps you plan for the unanticipated.

Another aspect to consider is young adults aged 18 to 27. This age group is allowed to stay on their parents’ insurance under the Affordable Care Act, though some may elect to establish their own policies. Though no parent wants to think about children developing an addiction, this is a period of experimentation.

Teenagers and young adults often experience their first exposure to alcohol and other drugs in this time period. Even moderate alcohol use can develop into a full-blown addiction within this vulnerable age range, so learning about alcohol addiction treatment centers in the area and if your insurance will cover them is essential.

Taking a Proactive Approach

There’s a chance you’ll never have to use your addiction therapy coverage – but it’s essential to be prepared in the event that you do. Research rehab facilities in your area that take insurance and seek a program that will provide affordable, high-quality addiction treatment services.

It’s best to plan for these contingencies while you’re switching or shopping for health insurance coverage. As a general rule, the higher your premium, the more extensive the coverage. For example, a plan with a higher premium may cover 75 percent of the cost of rehabilitation, while a lower premium may only cover 60 percent.

Your best plan will depend on your budget and other health needs. Ask your insurance company specifically about their portion of the cost, so you can determine what you’ll have to pay out of pocket. It’s much easier to plan these things out now than when a problem arises.

No one likes to think about the potential for addiction, but no one plans on developing an addiction either. By familiarizing yourself with your insurance coverage, you can make important decisions now that may be more difficult to make in the moment.

Are You Wondering How Your Insurance Can Cover You in Rehab?

Best Treatment Options for Your Specific Needs

How Will My Insurance Be Affected By Going to Rehab - ATS

Will Going to Rehab Raise My Insurance Rates?

Will Going to Rehab Raise My Insurance Rates - Addiction Treatment Services

Although it was once believed that addiction was the result of weaknesses in willpower or morality, it is now widely acknowledged that anyone can become trapped in a cycle of physical and psychological addiction. The medical community now understands that addiction should be treated with the same level of commitment, resources and respect with which they address other types of illness.

Addiction is a serious health concern that negatively impacts the lives of those who are dependent on substances. Addiction’s ripple effects also impact friends, family and co-workers.

Unfortunately, many people deny their addiction or put off treatment because they’re worried about what might happen if they go to rehab. But the longer an addiction goes on, the greater the threat to personal health and safety, and the greater the risk of major legal and career consequences.

Uncertainty about insurance coverage and how to pay for rehab is one of the issues that may delay seeking treatment for many individuals. Let’s look at how insurance coverage for addiction treatment works and address common concerns.

Will Going to Rehab Raise Your Insurance Rates?

No. Under the Affordable Care Act (ACA), insurance companies in the U.S. cannot raise rates or premiums for patients who seek treatment for one of the 10 “essential services” covered by the ACA, and substance use disorder is one of those essential services.

Under the ACA, insurance companies must cover addiction treatment the same way they cover other illnesses, and cannot charge more or deny coverage for pre-existing conditions.

However, it does not guarantee that the entire cost of treatment will be covered. What exactly is and is not covered will depend on the individual’s insurance plan.

Alcohol and Drug Rehab Insurance Coverage Under the Affordable Care Act

Insurance Coverage for Rehab Under Affordable Care Act Statistic - Addiction Treatment ServicesThe Affordable Care Act, also known as Obamacare, outlines 10 “essential services” that all insurance plans must provide coverage for.

One of those 10 essential services is:

  • Mental health and substance use disorder services (including behavioral health treatment)

The ACA also forbids insurance companies from raising premiums or denying coverage due to pre-existing conditions. This means that those who need rehab no longer need to worry about their addiction being labeled as a pre-existing condition that could affect future insurance coverage or rates.

Finally, the ACA requires that insurers charge the same rates to all patients on a given plan, regardless of factors such as age or pre-existing conditions. The level of coverage must also stay consistent regardless of the type of illness, which prevents insurers from discriminating against those with drug or alcohol addictions.

What Types of Addiction Treatment Services Are Covered by Insurance?

While the exact coverage depends on the particular insurance plan, plans generally cover the following types of addiction recovery services:

  • Inpatient/residential treatment
  • Partial hospitalization programs
  • Outpatient treatment (including Intensive Outpatient Programs)
  • One-on-one counseling
  • Group therapy
  • Recovery support services and education
  • Medication (for detox and maintaining sobriety)
  • Ongoing support groups

This is a general guide. You should check your insurance benefits statement to determine what your plan actually covers, or you can have a third-party professional review your insurance plan and break it down for you.

Will Insurance Cover the Full Cost of Addiction Treatment?

The answer to this question depends on the specifics of your insurance plan and the treatment program you choose. As with all insurance plans, there are specific limits and requirements. You may find that your plan covers all or only part of treatment.

However, the law does require that insurance companies pay at the same rates for rehab as they do for other types of medical treatment. This prevents insurance from charging more or covering less in an unfair way. How much coverage you will have will depend on your overall level of insurance benefits. Plans with more expensive premiums typically cover more than less expensive plans.

Because knowing what type of treatment is needed and how insurance covers this treatment can be confusing to people who are new to this topic, we highly recommend talking with an expert in this area. You can certainly call your insurance company to ask about coverage and rehab options. Just keep in mind that they may steer you towards providers that are in their network and the most affordable for them, not necessarily the best for you.

However, our insurance experts at Addiction Treatment Services can provide you with an objective analysis of your coverage and help you narrow down your treatment center choices based on your unique circumstances and needs.

How Can I Afford Out-of-Pocket Rehab Costs?

If you find that your insurance will only cover part of the cost of treatment, then the next step is to figure out how to pay the balance. Check with the rehab facility you’ve selected to see:

  • If they will allow you to pay in monthly installments;
  • If they can refer you to lenders who specialize in this type of financing; or
  • If they offer discounts for up-front cash payments.

Again, speaking to an expert in the area of rehab financing can save you a lot of time in this process. Addiction Treatment Services can help you with this as well.

When Is the Best Time to Get Addiction Treatment?

Now is the best time to get serious about going to rehab, for two reasons:

  • The longer addiction goes on, the more it harms the life of the addicted individual.
  • The Affordable Care Act may be changed in the future in ways that remove the consumer protections that are currently in place.

Before the Affordable Care Act, treatment for substance abuse and addiction was not always covered by insurance. Now, the ACA guarantees at least partial coverage to those who need it, and ensures that insurance companies treat addiction patients fairly. But if changes to the law occur, then it may once again become harder to get insurance coverage to help pay for addiction treatment.

There is no better time than the present to seek out the professional help needed to take back control from addiction. Right now, this is being made easier by the United States government through the Affordable Care Act. Take advantage of this opportunity to turn your life around for the better – without having to pay the full cost yourself.

Insurance and Intervention Help for Families

While insurance will cover some portion of treatment for addiction and substance abuse, navigating insurance coverage and claims can be very difficult without the help of a professional.

Addiction Treatment Services can help you with insurance verification, advise you on how to get the most out of the coverage you have, and then help you find a rehab program that is 1) covered by your plan and 2) a good fit for the type of treatment you need.

We can also advise families on how to stage an intervention for drug addiction so that their family member can understand the importance of going to treatment right away. With addiction, any delay in undergoing treatment can be deadly, so bringing in professional help speeds up the process.

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Does Insurance Cover Drug and Alcohol Detox Treatment - Addiction Treatment Services

Does Insurance Cover Drug and Alcohol Detox?

Drug And Alcohol Detox Insurance Options - Addiction Treatment Services

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 program 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 rehab 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

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Insurance companies look at a few different factors 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 coexisting 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. Your financial situation should never be a barrier to quality detox services and rehab 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 rehab 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.

Nation Still Faces Shortage of Treatment Beds

treatmentdocDespite the fact that the nation is clearly struggling with a drug abuse problem, there are not enough treatment programs to properly care for the growing number of users. Additionally, many families of addicts have not been educated on the effectiveness of rehabilitation facilities, or how successful drug and alcohol interventions can be.

This causes many substance abusers to go throughout life with their problems going unaddressed and some even fall victim to overdose deaths. The current reports indicate that almost 44,000 people in the United States die from drug overdoses a year. The number of people dying from overdoses has surpassed deaths caused by automobile accidents and other forms of injury as well.

Educating the general public as well as legislators on the necessity of treatment is an important job of public officials and healthcare providers. Anyone who is struggling with an addiction to drugs and/or alcohol increases their chances of achieving and maintaining sobriety if they enroll in a treatment facility. However, there is a constant problem with the lack of treatment programs and not enough beds in the treatment facilities that do exist for residential care.

“We know addiction treatment saves lives, reduces drug use, reduces criminal activity and improves employment. The data is there, the evidence is in, but our public policy has not caught up with the science,” explained Paul Samuels, president and director of the Legal Action Center.

There are generally two types of treatment centers available to addicts. Publicly-funded treatment centers generally fill up quickly and even have waiting lists that can be weeks long. Although maybe no an ideal situation, a large number of people are successfully helped in these programs every year.

The other type of treatment center is private pay. While these are often more expensive, it is more likely that they will have a bed available for someone to enroll. Oftentimes these types of treatment centers take insurance as well, and with expanded coverage there has been a bit more access.

In order to put a significant dent in the amount of people who suffer from addictions to drugs and alcohol, more treatment options need to made available. While the current White House Administration has proposed additional funding to increase treatment capacity, it really takes much more of a policy shift to accomplish substantial change. Lawmakers must enact ways to not only make more beds available, but also support best practices that are successful in getting people enrolled in treatment.