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?

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. 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 am 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?

If you have any additional questions about your insurance policy or coverage, it’s best to reach out to your insurance company directly. They can answer questions about your specific policy, what it covers and coverage amounts.

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Q: How much does rehab cost with insurance?

The average cost of treatment varies widely, depending on whether the rehabilitation is inpatient or outpatient, the facility’s location, the services they offer and the amenities available on their campus. A basic nonprofit facility in a suburb may cost nothing, but a full-service beachside rehab for celebrities can cost up to $80,000 per month. The average is somewhere around $2,000 to $25,000 per month. While most insurance providers cover a portion of addiction treatment, the amount they will pay toward those costs also depends on a variety of factors, such as whether or not they cover rehab stays, the length of your stay, your copayment amount and more. The best way to find out if your provider offers coverage or how much they will pay is to call them and ask. Learn more about the costs of rehab.

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