As you compare the services and costs of various rehab programs, you’ll notice that facilities differ in the types of payment they accept. While some programs accept insurance, others accept only cash payments. The first step in your search is to verify whether the facility accepts insurance; the second step is to find out whether services are covered under your plan. An intake specialist will take your insurance information and help you determine whether your insurer will cover care at that facility.
Depending on the type of plan you have, you may be asked to pay a deductible or copayment for your treatment. You may also be asked to pay an additional amount for specific services, like prescription medications or consultations with specialists. Discover more with the following insurance FAQs.
- Does insurance cover substance abuse treatment?
The Mental Health Parity and Addiction Equity Act of 2008 requires group plans covering more than 50 employees to provide mental health coverage — including coverage for substance abuse treatment — that equals the coverage provided for medical conditions.
While the act benefits employees who work for larger companies, it does not apply to small group plans covering 50 or fewer employees. It also does not apply to individual insurance plans. However, some individual and small group policies do extend coverage for substance abuse treatment.
Signed in 2010, the Affordable Care Act (ACA) made substance abuse treatment one of the essential health care benefits available to Americans. As of 2014, policies sold on Health Insurance Exchanges must provide coverage for drug or alcohol rehab. The ACA is expected to make substance abuse treatment part of primary care, focusing on prevention as well as recovery. It will also cover treatment at all stages, from early substance abuse to full-blown addiction. However, the services that must be covered are still being determined, and the regulation applies to adults who are newly eligible for coverage. If you have an existing policy, it may or may not cover the type of care you’re seeking.
In addition to federal regulations, state laws can affect insurance coverage for addiction treatment. Because each state can establish its own guidelines, it’s important to check with your insurance company about the specifics of your plan or policy.
- What will insurance pay for?
Today many individual and group insurance policies do cover substance abuse treatment, usually as part of their mental or behavioral health services. However, there are certain limitations that may apply:
- The policy may only cover certain levels of care (for example, detox and outpatient services may be covered, but not inpatient treatment).
- The policy may cover only certain types of facilities, such as dedicated detox centers, hospitals, or outpatient clinics.
- The policy may only cover services for a certain period of time (a policy may be limited to 30, 60, 90, or 120 days of treatment).
- The policy may limit treatment to a certain number of days per year or per lifetime.
- The policy may cover only rehab facilities in its authorized provider network (if you go to an out-of-network provider, you may be charged a higher copayment, or the services may not be covered at all).
The extent of your coverage will depend not just on your insurance company, but on your policy itself. The most accurate way to determine exactly what your insurance will cover is to review your policy manual or to call the provider directly.
- How do I know if I’m covered?
To find out if you or a loved one are covered under an insurance policy, call the company’s toll-free number. Many companies have separate numbers for behavioral and mental health services, which can be found on your insurance card. A representative should be able to provide information such as:
- Your coverage status
- The dates that your coverage is valid
- The services that your policy covers
- The amount of your deductible or copayment (the portion of the costs that you are responsible for)
An insurance company representative may not be able to verify coverage for a specific service or treatment provider over the phone. Some plans require that a request for authorization be submitted before payment can be approved.
It’s not always easy to understand the legal language of insurance contracts or to make sense of the rules and restrictions of a policy. As part of the admission process to a rehab center, you should have the guidance of an intake counselor or insurance verification specialist who can help you figure out your financial responsibilities. Most treatment centers that accept insurance have staff members who will help you request authorization for care from your provider.
- Is my coverage confidential?
Many people hesitate to seek substance abuse treatment because they’re afraid of repercussions from their employer. They may be concerned that they will be demoted or fired if their employer finds out that they have a substance abuse problem. They may also worry that their insurance carrier will drop them from the plan or restrict future coverage.
The law protects the privacy of individuals seeking drug or alcohol treatment through the provisions of 42 Code of Federal Regulations (CFR). To ensure that people who need rehab will not be discouraged by the stigma associated with addiction, 42 CFR imposes limits on the information that can be released by treatment centers that receive funding from the federal government. The law states that any records that identify the patient as a substance abuser or as a participant in a rehab program may not be disclosed to any entity — even for the purpose of payment or medical treatment — without written consent from the patient.
Because many treatment facilities receive some form of financial support from the government, 42 CFR applies to a wide range of rehab programs across the country. Facilities that do not receive federal assistance may still be subject to state privacy regulations. Programs that do not comply with these privacy regulations face criminal penalties, including fines of up to $5,000 for each offense.
- How do you verify my health insurance benefits?
After you fill out our online form, your health insurance verification information is obtained electronically from your insurance provider. Because every health care policy is different, one of our intake coordinators will reach out to your insurance provider to verify the accuracy of these results and find out if any exceptions apply. This service is performed as a complimentary courtesy for all new patients.
- Can you explain what the results of my health insurance verification mean?
In the “Insurance Verification Help” section, you’ll find a brief explanation for each piece of information generated by our health insurance verification system. If you’re still confused, the intake coordinator contacting you will explain your results in more detail. During this call, they can explain how your coverage applies to our facilities, and what your results mean for your potential out-of-pocket treatment costs.
- Who do I call if I have additional insurance questions?
In the event that your provider does not approve coverage for The Recovery Village, we are standing by to assist with information for private pay options and possible cash pay scholarships at reduced rates. It is our goal to assist you as much as we possibly can to obtain quality care and treatment options. We will do our best to make treatment available and help you find the treatment you need.
Additional Insurance FAQs
Advanced Recovery Systems
ACEP No. 6874