It is common for the price of addiction treatment to be a concern for those who need help. However, people with health insurance can significantly reduce and, in some cases, fully cover the cost of treatment.
While there are other ways to help cover the costs of drug and alcohol rehab, insurance is the most practical way to ensure that the cost of rehab is not your primary concern. Once funding is secured, individuals and their families can focus on what matters: finding a program that will help them heal.
What kind of addiction treatment does insurance cover?
Depending on the plan specifications, people with insurance may apply their coverage to the following:
- hospital care (from an approved facility)
- outpatient care (from an approved provider)
- detox(when deemed medically necessary)
- follow-up counseling
What mental health conditions qualify for insurance coverage?
People who struggle with substance abuse are more likely to have a mental health disorder such asmajor depressive disorder;or generalized anxiety disorder. Insurance companies are required by the federal Parity Act to treat mental and behavioral health coverage the same as medical/surgical coverage.
It is essential to check the details of your plan, as the Parity Act does not require insurers to provide mental health coverage. Instead, the law requires that if they provide mental health coverage, it must be the same as medical coverage.
For example, if a person's insurance provides $40 to cover an appointment for a broken bone, it must also provide $40 for a consultation.
The most reliable way to verify your coverage is to look up the required one-page summary of behavioral and mental health coverage.
General drug and alcohol rehab insurance coverage options
Generally speaking, there are three insurance options that can help.covers the cost of addiction treatment. These include:
- group insurance
- public insurance
- private insurance
After the Affordable Care Act (AFC) was passed in 2010, health insurance was required to cover mental health and addiction services.
While coverage may vary, they must provide some financial assistance for addiction treatment.
Group insurance plans are generally provided to employees by their employer. People with employer-sponsored coverage will likely have the option to choose any of the following:
- choice of health insurance plans
- they pay something on all their monthly premiums
- they deduct their portion of the premium from your salary each pay period
Depending on the employer, one's group plan may be partially or fully covered. Addiction treatment coverage will vary from plan to plan, but generally includes some mental health coverage and basic health benefits.
Group insurance benefits also depend on the size of the company. Businesses with more than 50 full-time employees will cover the top ten benefits, including addiction treatment.
By comparison, companies with more than 50 full-time employees will have more freedom in choosing their coverage options.
The United States government funds public insurance. The two main types of public insurance are Medicare and Medicaid. Medicare is a program designed for people age 65 and older and people with disabilities. Medicaid is public health insurance for people and families with low incomes or disabilities.
If someone can't get coverage through their employer, they will still require coverage for themselves and their families. Often this means they will purchase an individual health insurance plan.
Although individual plans may not be as convenient as receiving group benefits through an employer, people:
- buy a plan that covers them and their family
- make all monthly premium payments
- become more familiar with and manage all of your health coverage and benefits
Individual programs can only be purchased during the open enrollment period. Individuals can only enroll during this period unless they qualify for special enrollment due to life-changing events. These events include:
- need coverage for a new baby
- change of coverage for marriage or divorce
- job loss or loss of coverage from an employer;
After each event, people have up to 60 days to change their plan or sign up for a new one.
Private insurance is perhaps the most flexible type of coverage for people seeking addiction treatment. These insurance plans may covermore treatment optionsthan others and have fewer restrictions on where one can sign up for treatment.
Private insurance generally falls into one of the following categories:
BPI: Preferred Provider Organization
PPO or Preferred Provider Organization insurance gives people a lot of flexibility. With this plan, you don't need a primary care doctor. Instead, you can go to any health care provider you want without a referral. These plans work in and out of your network.
When you stay in-network with a BTI plan, you'll generally have lower copays and comprehensive coverage. If you choose to go out of network, you will have higher out-of-pocket costs and not all services will be covered.
HMO: Health Maintenance Organization
HMO or health maintenance organization insurance requires people to choose a primary care physician. As a result, all health care services must go through this doctor. Because of this, people will need a referral to see other health professionals, except in an emergency.
With HMO plans, visits outside of your network may not be covered. The benefit of HMO insurance is that coordination of all health care through doctors means less red tape and lower health costs for everyone.
Point of Service (POS) plans
Point of Service plans operate over a defined network, usually tied to a geographic area. POS plans allow people to pay less to use doctors, hospitals, and other health care providers that are part of the plan's network.
POS programs require people to get a referral from their primary care provider to see a specialist.
Exclusive Provider Organization (EPO)
Exclusive provider organization insurance is a managed care plan where health care services are covered only if people use doctors, specialists or hospitals in the plan's network, except in emergencies.
How to Determine Your Drug and Alcohol Rehab Insurance Coverage
The best way to determine how addiction treatment is covered by your insurance is to call your provider and ask for this information. You can also contact our admissions team to verify your coverage. An admissions counselor can provide you with an estimate of the cost of treatment, without obligation.
Some things you should definitely ask include:
- copay amount
- upper limits
Factors That May Affect Insurance Coverage
The cost covered by an insurance plan will vary depending on the insurance company, the plan, and the rehab center. In general, most private insurance plans will cover 40 to 80 percent of all addiction treatment costs.
It's important to note that other factors can affect how much a plan will pay for treatment, such as:
- In-network vs. out-of-network:As noted above, depending on the type of insurance you have, if the treatment center is out of your network, your plan may cover less or none of the cost of treatment.
- Treatment duration:In some cases, insurance plans will only cover short-term treatment options, such asPrograms of 28 or 30 days. Conversely, other plans may cover long-term treatment if it is medically necessary.
- Approve first:Some insurance plans will require the person to declare their treatment to the insurance company before beginning treatment. If they do not get this prior approval, they will be 100 percent fiscally responsible for the costs of their treatment.
- Medical necessity:It is common for insurance companies to require that addiction treatment be deemed medically necessary by a healthcare professional before they will cover the cost of treatment. Your primary care physician or an addiction treatment provider will evaluate you for signs of drug abuse, addiction, or dependency.
- Detox Requirements:If it has been deemed medically necessary for someone to receive addiction treatment, they may need to undergo rehab. This is especially true for people struggling with addiction to substances that cause severe withdrawal symptoms, such as alcohol and opioids.
It is vital that you confirm your coverage before beginning treatment to ensure your peace of mind and allow you to focus on your recovery.
How to find a rehab center that accepts my insurance plan
Each rehab center has a list of insurances they accept. It is also common for treatment centers to provide people with payment plan options to help with remaining balances, such as fees.
A typical rule of thumb is if a rehab center accepts public insurance. the treatment options they offer are often more restrictive. This is because much of your facility will be subject to federal guidelines, which may be affected by state and local laws.
Insurance accepted at Elevate Addiction Services
For people seeking treatment at Elevate Addiction Services, we accept the following insurance carriers:
- BlueCross BlueShield
- Health Network
- value options
If your insurance company is not listed, please contact our admissions team or securely verify your insurance on our website.
What Substance Abuse Costs You: Is It Worth the Cost of Treatment?
Attending a reputable rehab center can be more expensive than state-sponsored treatment centers. However, as with many things in life, you get what you pay for. Treatment centers like Elevate Addiction Services provide quality care that will help you deal with the essence of drug abuse, not just its symptoms.
The true cost of one's addiction depends on the substances of abuse and your geographic location. But in many cases, it is more difficult for them to remain addicted than it is to attend treatment.
Drug and alcohol addiction treatment.It will also vary in price depending on:
- services offered
- services provided
To learn more about insurance coverage for addiction treatment, contact an addiction specialist today.
See Information on Individual Insurance Policies:
- Blue Cross Blue Shield insurance coverage for drug rehab
- Health network insurance coverage for drug rehab
- Aetna drug rehab insurance coverage
- Cigna insurance coverage for drug addiction
- UMR Insurance Drug Addiction Coverage
- Drug addiction insurance coverage from Humana
- ValueOptions insurance coverage for drug addiction