Accepted Insurance for Addiction Treatment
Drug addiction is an incredibly serious disorder that affects millions of US citizens. It can severely impact their quality of life.
Luckily, a substance abuse problem isn’t a death sentence. There are many organizations that can help addicts overcome their chemical dependency.
They’ll rely on tools like talk therapy and medications to manage the symptoms of withdrawal. Plus, they can offer all sorts of support like a 12-step program.
Unfortunately, a stint in a drug rehab center can cost an arm and a leg. Depending on the facility, the service can be exceptionally expensive.
That’s why most addicts rely on insurance to help pay the expenses. At this point, you may ask, what are the accepted insurances for addiction treatment?
If that’s the case, we can help you out. In this article, we’ll go over the plans that offer extensive medical coverage.
Understanding Insurance Coverage for Addiction Treatment
With health care costs at an all-time high, insurance has never been more important. Countless US citizens rely on the coverage to ensure they have access to treatment.
This can significantly reduce the expenses associated with drug addiction rehabilitation.
That’s because mental health and substance abuse are essential health benefits. So, all insurance plans must cover a few services.
- Drug addiction treatment
- Behavioral health treatments like talk therapy and support groups
- Mental and behavioral health treatment for inpatient addicts
On top of that, the plans should cover all pre-existing mental disorders.
Mental Health Parity and Addiction Equity Act (MHPAEA)
In 2008, the US passed the Mental Health Parity and Addiction Equity Act (MHPAEA). This is a law that provides protection for people who suffer from mental disorders.
It states that insurance must treat medical services and mental health care equally. That means they can’t impose less favorable limitations on mental health care.
So, patients should have similar access to medical or surgical services and mental care.
Commonly Accepted Insurances for Addiction Treatment
Not all insurance plans are equal. Some provide extensive coverage, while others only focus on the basics.
In this section, we’ll take a look at the most common types of plans.
This type deals with people who have an insurance policy from a private organization. With a private plan, you’ll have more control over the drug rehab center you go to.
You can choose any organization you like based on location and professional expertise.
Plus, the plan will take care of most of the costs of mental health disorders and addiction.
Yet, you may have to pay an additional deductible, depending on your policy. For instance, if you choose an out-of-network facility your expenses will be higher.
Sadly, this means private insurance is the most expensive type on our list.
Some of the plans offered by private insurers include:
- Blue Cross Blue Shield
- First Health Insurance
- Carelon Behavioral Health Options
When you sign up for a new job, chances are your employer will provide you with health insurance. Luckily, this should help cover most of your addiction treatment costs.
The plan will pay for doctor visits and medication expenses. Although, the coverage will depend on your specific policy.
Besides that, you’ll get access to Employee Assistance Programs (EAP). This service can provide free, private assessments and short-term counseling.
Not only will it help with substance abuse disorders, but it’ll provide tools to manage the stress of work.
On top of that, health coverage isn’t dependent on you keeping your job. That’s thanks to the Consolidated Omnibus Budget Reconciliation Act (COBRA).
This allows people to continue using employer insurance, even after losing their jobs. Yet, this service is only valid for a limited amount of time.
Medicaid can help addicts get access to drug abuse treatment. The organization will finance most of the expenses related to chemical dependency.
Yet, the exact coverage will depend on your policy and the state you live in.
For instance, Utah and Indiana cover substance use disorders and serious mental issues. As for Texas and Florida, getting help for drug abuse problems may be difficult.
Moving on, Medicaid expanded its services with the Affordable Care Act (ACA). This gives nearly all adults in the country access to substance abuse treatment.
Although, they need to have an income that’s greater than 138% of the federal poverty level.
Medicare provides a wide range of plans for its customers. Each one has a set of requirements and limitations.
For starters, Part A should cover medical expenses related to substance abuse. Yet, this only applies to inpatient services.
Moving on, Part B will pay for outpatient treatment services. This includes psychotherapy in clinics or hospitals.
Other than that, there’s Part C or Medicare Advantage Plan. This policy will help addicts with the cost of prescription medications.
It’ll pay for drugs like buprenorphine and methadone. Both of these can relieve the symptoms of withdrawal.
Finally, Part D is a supplemental policy that can lower the costs of medications.
Factors Affecting Insurance Coverage for Addiction Treatment
Now that you know the types of insurance coverage, we can move on to the factors that’ll affect the policies.
First up, your insurance provider will check for medical necessity. It’ll ensure that you’re actually in need of the services you’re asking for.
So, to qualify, you’ll need to present documentation that backs up your condition. That may include reports like medical records.
Aside from that, each coverage plan has a few limitations. For example, some of them will put a ceiling on the duration of treatment.
That means addicts will only have access to the service for a limited amount of time. Plus, most plans won’t cover all substance abuse issues.
Some focus on treating alcoholism, while others are more suitable for narcotic addiction.
Other than that, you have to consider the out-of-pocket expenses. That includes your deductibles, copayments, or coinsurance.
You won’t have access to drug abuse treatment if you can’t pay for the services.
Finally, before you get any help, you’ll need to apply for prior authorization and utilization. That’ll give you permission to take advantage of your policy for addiction treatment.
Although, getting this authorization may take a long while. Unfortunately, this can delay your access to treatment.
Seeking Insurance Coverage for Addiction Treatment
At this point, you should have all the information you need to seek insurance coverage. To make your life easier, we’ll give you a few tips that’ll simplify the process.
Right off the bat, you have to understand your insurance policy’s limitations. Check the plan to find out what it’ll cover when it comes to addiction treatment.
Usually, all the data you need will be in the Summary of Benefits and Coverage (SBC).
Yet, if you’re not familiar with medical terminology, reading the summary can be tricky. Fortunately, you should be able to call your insurance provider instead.
Lastly, make sure you use the case manager and patient advocate services. These will put you in touch with a professional that can walk you through all the available services.
Plus, they’ll talk you through the best treatment plans for your specific needs.
Alternative Options for Financing Addiction Treatment
If you don’t have medical insurance, it’s not the end of the world. There are plenty of addiction treatment facilities that rely on alternative financing.
First up, you can apply to state-funded programs and grants that don’t need insurance coverage. These will help you pay for any treatment plans you need.
Moving on, there are a couple of treatment facilities that operate on a sliding scale. That means, based on your income, the cost of the rehab services will change.
Finally, you can always opt to pay for the rehabilitation out of pocket. Addicts can use savings, loans, or crowdfunding platforms to raise capital for treatment.
Overcoming Insurance Barriers and Advocacy
Even if you meet the criteria for addiction coverage, you may face other barriers. For instance, your provider may deny your claim due to a lack of medical necessity.
If that happens, you don’t need to panic. There are still a few things you can do about the issue. First up, you may appeal the results of the denial.
Your insurer will give you a chance to provide further evidence to support your claim. Although, this process may be tougher than it sounds.
That’s because you have to navigate a lot of medical jargon and understand your rights as a patient.
So, you’ll need to carefully read through your policy and find out what you can ask for. This will make reapplying for addiction coverage much easier.
Lastly, it may be best to ask for an advocate to represent you. They’ll have extensive knowledge about the details of your health insurance plan.
Because of that, they should be able to help you resolve issues that you face with your insurers.
There’s a wide variety of accepted insurances for addiction treatment. We can classify these into four types, private, employer-sponsored, Medicaid, and Medicare.
Each one provides a unique service with distinct limitations and coverage.
Besides that, there are a few factors that may impact your coverage. These include medical necessity and prior authorization and utilization.