How to Pay for Drug Rehab: Avmed Insurance 

When you or a loved one is struggling with a drug or alcohol addiction, it may feel like there’s nowhere to turn. Health insurance in the United States is complicated, and you may not be sure what kind of treatment you can get with your coverage. Since its inception in 1969, AvMed has grown to provide health insurance coverage for nearly 300,000 people in Florida. Covered under the company are plans for employers, individual plans, family plans, and Medicare Advantage plans.

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Forms of Treatment Covered by AvMed

The exact coverage and treatment vary widely, depending on your plan. As a general rule, though, AvMed may cover any of the following:

Inpatient and Residential

Inpatient treatment is done through an overnight stay for several days, weeks, or months at a hospital or residential treatment facility. During your stay, you’ll receive access to medical care, individual therapy, group therapy, creative therapies, educational programs, and recreation. You may also have access to family therapy services to help heal bonds and foster a supportive environment when you get home.

Partial Hospitalization

Partial hospitalization programs, more commonly abbreviated PHP, are often operated by the same facilities that run inpatient rehab programs. Some people may begin treatment in a PHP, while others might transition to a PHP after they’ve finished a full residential or inpatient program.

A PHP is similar in structure to an inpatient program. There are multiple different types of therapy and activities offered for several hours every day. Unlike inpatient programs, however, you go home at night. Depending on the program, you might meet four, five, or seven days of the week.

Intensive Outpatient

Intensive outpatient programs, commonly abbreviated IOPs, are the next step down in intensity from partial hospitalization programs. In a typical IOP structure, you’ll spend two to three hours in therapy for two to four days of the week. For some people, this is the first step, and for others, it serves as a transition out of inpatient or PHP treatment.

IOP treatment is sometimes favored by people who can’t afford to take a lot of time off work, but who also know they need more help than they could get in a relaxed outpatient setting.

Standard Outpatient

Standardized outpatient treatment is designed to be worked into your day-to-day life. Most standard outpatient programs involve meeting with a counselor for individual or group therapy one time per week. Depending on the level of help you need with your addiction, you might opt for a plan that meets multiple times per week.

Researchers recommend beginning addiction treatment with a more intensive treatment program before transitioning to standard outpatient care. It’s tough to detox and weather the first few weeks of sober living without the extra help.

Detox

Detox programs are different from standard addiction treatment. Some inpatient facilities offer detox programs, though you might also detox at a separate facility that specializes in this.

Medically supervised detox has benefits no matter what substance you’re addicted to. A person who undergoes a medically supervised detox has a much lower chance of relapse during the detox process. Medical detoxes also have better pain management options than detoxing alone.

That’s without taking into account times when detox can be dangerous. Certain substances, most notably benzodiazepines and alcohol, can cause severe withdrawal symptoms when you stop taking them without warning. Both can cause seizures. Alcohol withdrawal effects are so potent that they can be fatal if not appropriately managed.

Addictions Covered

Many programs and facilities are capable of treating every form of addiction. AvMed insurance plans tend to provide coverage for a full range of substance abuse issues. This includes opioids, heroin, benzodiazepines, stimulants, marijuana, prescription drugs, and alcohol.

Specific Treatment Aspects That AvMed Will Pay For

 The dollar amounts of coverage and the specific treatments covered will vary depending on the plan. Assuming that your AvMed plan includes rehab coverage, though, it will typically help with the cost of standard treatment services like:

  • Initial intake assessments and examinations
  • Psychological and social health assessments
  • Other psychiatric and medical exams
  • Detox treatment in a medically supervised program
  • Any prescribed medications
  • Group and individual therapy and counseling
  • Meals and overnight stays in inpatient and residential facilities

Will My Boss Know?

Whether you receive your AvMed health insurance coverage through your employer or not, the treatment center cannot tell anyone outside the facility that you’ve been admitted as a patient. Patient confidentiality is protected by HIPAA, a set of federal laws with stringent penalties for violations. As such, health providers are very serious about guarding your protected health information. Protected health information covers treatments and services provided, payment for services, and any physical or mental conditions that you’re being treated for.

In a few rare circumstances, your provider might need to reveal your private health information without your consent. However, none of these situations would involve your employer. One example is if there’s a medical emergency, and your healthcare provider must inform another provider of relevant information regarding treatment. Another example will be if a court subpoenas the info.

If you have concerns about your healthcare confidentiality, you can talk to your healthcare providers to get more detailed information regarding how HIPAA protects you. But the bottom line is that if you don’t want to disclose your addiction to your employer, you can still seek treatment regardless.

Out-of-Pocket Costs

Though AvMed may cover a large portion of your treatment, you can still expect to pay some out-of-pocket costs. These will vary depending on your plan. If you have a deductible, you’ll need to pay a certain amount of money before your insurance coverage goes into effect. You’ll also have co-pays, which you pay out-of-pocket for each service you receive.

Because drug rehab programs are so expensive, you’ll typically need to get a preauthorization from AvMed before you enter the program. This means that you’ll need to inform AvMed of your need before you start treatment, rather than billing them afterward. If you don’t get the appropriate authorization, AvMed might deny your insurance claim entirely.

To obtain the preauthorization, you’ll need to provide information about your medical needs to AvMed. They’ll then decide whether the care is a medical necessity. Inpatient rehab nearly always requires preauthorization, and some outpatient services might also need preauthorization.

The regulations regarding preauthorization are complex. Some cases allow for preauthorization to be obtained within 48 hours after you’re first admitted to treatment. But in others, you’ll need to get the authorization before you’re admitted at all.

Navigating Authorizations

To find out whether your situation requires preauthorization, you can call AvMed and explain your situation, the method of treatment you’re seeking, and your concerns. The insurance representative can examine your plan and tell you whether you need authorization. Health emergencies don’t require approval before you get emergency medical care.

In many cases, your healthcare provider can initiate the request for you. This may be your general practitioner, or it may be an intake counselor at the rehab facility of your choice.

When getting authorization, make sure to ask for specific details, including how many services are covered, how many prescription medications are included, and whether the company will cover ongoing room and board if you stay at a residential facility.