How Does Insurance Work for Addiction Treatment?

How Does Insurance Work for Addiction Treatment?
Sunday, May 20, 2018

Health insurance companies do not make a profit unless their customers lead healthy and productive lifestyles.



(press release: summitbehavioralhealth) // New Jersey // Maria Ulmer MA, LMFT, CAADC | Chief Operating Officer

Once a person has made the decision that he or she needs to seek treatment for addiction, one of his or her main concerns is how to pay for it. The good news is that there are some insurance options for them to choose from to help with the cost of addiction treatment. Both public and private health insurance typically covers at least a portion of the expenses for inpatient and outpatient treatment for all types of addiction.

As addiction awareness has increased over the last several years, insurance companies have come to a better understanding that addiction is, in fact, a medical condition that is very treatable. They recognize that covering the cost of addiction treatment can be far less costly than covering the costs of all the negative medical effects of substance abuse, including psychological or psychiatric care that often accompanies both substance addictions and behavioral addictions throughout an addict’s lifetime. So now, insurance providers view addiction treatment programs as a precautionary medical concern.

Health insurance companies do not make a profit unless their customers lead healthy and productive lifestyles. Thus, they typically make it a point to offer coverage, or partial coverage, of addiction treatment to individual policy-holders as well as employers who offer employees health insurance.

If you need help determining if you have access to benefits for addiction treatment, whether it is partial or complete coverage, and which facilities are covered by your policy, you can contact your health insurance provider to find out. Knowing what is available to you is important because the cost of treatment can be a major expense.

Public Insurance

For those individuals whose insurance doesn’t include behavioral health coverage or substance abuse treatment programs, they may be able to obtain public insurance to make inpatient treatment affordable. Some treatment facilities are partially or completely subsidized by the government, so they accept federal or state medical insurance for full or partial payment for their services. Those facilities often have specific guidelines, like income requirements, so you would have to contact them to see how to determine whether you qualify for their programs.

In situations where inpatient treatment isn’t feasible or available, you may find nonprofit organizations that provide addiction treatment programs that accept monthly installment payments using a sliding scale based on income to determine the cost. While payments may continue long after the addiction treatment program is completed, using one of these types of facilities may allow you to get the help you need while keeping monthly payments as low as possible.

If you are thinking about addiction treatment, you should evaluate your insurance plan with your agent, insurance provider, or your employer’s benefits department to find out exactly what they will cover and what you will be responsible for.

Private Insurance

Obtaining private insurance may cost you more than public insurance, but typically the healthcare choices you receive is more comprehensive than what is provided by government-supported plans. These benefits are especially helpful when you realize that you or someone in your family needs addiction or substance abuse treatment.

Private insurance is any healthcare insurance that is provided by an employer or that is obtained and paid for by an individual. People who have private insurance are able to avail themselves to a wide selection of benefits, including:

  • A bigger selection. With private insurance plans, you will find that there are a large number of drug and alcohol rehabilitation facilities and programs to choose from.
  • Price. You will likely not have a lot of out-of-pocket expense for addiction treatment if you have private insurance. Of course, that depends upon your deductibles, but it’s typically a lot less expensive than if you had public insurance.
  • Inpatient drug or alcohol rehab. Residential treatment, where the patients live for a period of time, is often the best solution for early recovery. With private insurance, you are more likely to be able to afford residential care.
  • High-end drug and alcohol rehab. Your private insurance may even allow you to attend more exclusive rehabs. They usually offer more luxurious amenities than regular residential treatment, like gourmet food, private rooms, and fitness instruction.
  • Holistic rehab facilities and programs. These types of programs include traditional addiction treatment in conjunction with holistic approaches to recovery like acupuncture, meditation, and yoga.

Before You Decide Which Treatment is Best for You

It’s important that before you enter into treatment for drug or alcohol abuse or addiction, you understand exactly what your insurance benefits will and will not cover. You don’t want to find yourself in the vulnerable state of early recovery having to deal with shouldering the whole expense of your treatment.

Sometimes people who are seeking treatment for addiction don’t want their employers to find out about their addiction. Unfortunately, it’s usually necessary to consult with employers and their benefits departments in order to get the information necessary to attend treatment. If you have to take a leave of absence from work, know that there are laws and regulations that your employer has to follow regarding keeping your position with the company secure. The Family Medical Leave Act is something you should look into, as well as any short-term disability benefits your employer may be able to provide. If your employer offers it and you qualify, you may be able to continue to receive a paycheck even while you are in treatment.

Don’t assume that because you don’t have spectacular health insurance that you can’t go to rehab. At Serenity at Summit, we can help you explore what your insurance covers, and how you can attend treatment without financial hardship.



source: https://www.summitbehavioralhealth.com/blog/insurance-work-addiction-treatment/