Not having the money to pay for addiction treatment stops many people from getting the help they need. But even people who have health insurance may be unsure of what rehab expenses are covered and which ones are not—and that uncertainty can also deter people from seeking care.
Treatment is expensive, so concerns about cost are understandable. However, money is not a reason to pass up an opportunity to get help. According to data from the 2015 National Survey on Drug Use and Health (NSDUH), an estimated 19.3 million people age 12 and older who were classified as needing substance use treatment did not receive it at a specialty facility in 2015.
That’s almost 20 million people who needed services for a substance addiction who did not receive them. For many of them, the cost was likely a barrier. You; however, don’t have to be in the group of people who do not seek drug treatment.
At Pathway to Hope, we work with your insurance provider to help you get the most out of your addiction treatment insurance coverage. The services insurers will pay for in drug and alcohol rehabilitation services vary according to the plan you have, so it will take some research to understand what specific benefits are offered under your coverage.
When you call us, we will aim to provide a comprehensive review of your insurance benefits to make the financial part of treatment as stress-free and easy to understand as possible. Below are some commonly asked questions clients have about health insurance and how it relates to different substance abuse treatment programs and options. If you’d like to speak to an intake specialist now, give us a call now at 1-844-557-8575.
As the National Institute on Drug Abuse explains, addiction treatment is delivered in diverse settings with a variety of behavioral and pharmacological approaches. Addiction recovery will not look the same for everyone, because everyone is different. It’s a good thing that programs and services can be customized to fit each person’s situation and specific needs.
With nearly 15,000 specialized substance abuse treatment facilities across the U.S., clients have many options to choose from. While a health plan will typically provide substance abuse treatment coverage, the reality is that not every facility or treatment type will be covered by a particular health plan.
Many insurance providers know and understand that addiction is a treatable medical condition. As of 2014, under the Affordable Care Act (ACA), your plan is required to cover 10 health services known as Essential Health Benefits, regardless of the kind of insurance you have. Those include help with mental health issues, drug or alcohol abuse, and counseling and therapy. However, what’s covered varies, and whatever services are not covered by your insurer must be paid by you or another financial source. Whether or not a facility is covered, the amount of coverage provided by your health plan is determined by factors such as if the facility is in-state or out-of-state. Much will depend on whether you have public insurance, private insurance, or group insurance.
Treatment facilities that are partially or completely subsidized by the government accept state or federal health insurance plans for full or partial payment of services. Keep in mind that these plans generally have specific income guidelines. Public insurance includes Medicare, for people age 65 and older, and Medicaid, which is for low-income households.
This kind of insurance costs more money, but it also offers you more health care options that can meet your needs and is more comprehensive than government-subsidized insurance plans. These options can include inpatient or residential rehab, holistic therapy treatment, luxury rehab, and other treatment options that do not fall under public insurance.
Private insurance is paid for by either the individual or an employer. It is not financially supported by the federal government or its agencies. In addition to having more options, private insurance plans pay a large portion of treatment costs. Your deductible, the amount you have to pay before your health insurance covers the bills, also factors into how much you’ll spend, but the amount you pay likely will be less than what you would pay if you had no insurance.
In private insurance, the three main managed care plans are:
They typically cover care costs from in-network providers, which makes them more affordable. If the drug or alcohol rehab center you are considering is listed as “in-network,” meaning it has an agreement with your insurance company, the rates of some services will be offered at a lower or discounted rate. If the rehab is “out of network,” which means they don’t have an agreement with your insurance company, your out-of-pocket costs can be higher.
PPOs work with in-network providers but may cover some costs from out-of-network providers. Going outside of the network may cost you more, however. You also may have to pay costs upfront and work with your insurance company to get a reimbursement.
A POS is the most flexible of the three plans. People with a POS can seek care from HMO and PPO providers when they need care.
Under this plan, an employer provides health care coverage to a select group of people. Because there are more people, these plans cost less for participants than individual plans that offer the same benefits, explains Investopedia.
People in these plans who want to use their benefits to cover addiction treatment may be concerned about losing their jobs. However, under the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, health insurance companies are required to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical or surgical care.
The Affordable Care Act expands MHPAEA’s requirements by ensuring that plans offered in the Health Insurance Marketplace cover many behavioral health treatments and services, SAMHSA explains.
Check with your group plan to see what services are covered.
At Pathway to Hope, we aim to make the insurance verification process as simple as possible. Here is a list of the providers we work with:
If you do not see your insurance provider listed, you are still encouraged to give us a call at 954-866-4756 and let one of our representatives discuss full and partial private payment options and help work with you to create a practical financial plan.
A concern that often arises among potential clients is whether treatment for their specific substance dependency will be covered by their insurance plan. As long as your plan lists addiction treatment as a covered benefit, then care will be provided, regardless of the source of the addiction.
It’s important to know what kinds of substance abuse treatment your plan covers. While many insurers are generally likely to provide full coverage for outpatient care over inpatient or residential care, which are longer in duration, what matters most is that you choose the treatment program and services that are most effective for a successful recovery.
Some health insurance plans include coverage for all substances to simplify things, but that doesn’t mean the provider will cover all treatment or therapies, or even medications. Aftercare services, which are essential to the addiction recovery process, may not be covered by a particular insurance company.
This is why Pathway to Hope will work with you if your health plan does not cover certain treatments, medicines, or services, or maybe just partially covers them. We work with you on a partial private-pay plan that is within your means and makes the necessary treatment an option.
If you’re unsure about which services or programs your insurance plan covers, the best thing to do is call your insurance provider or job’s benefits department for guidance on your options. During that call, ask the representative if you will need a referral from your primary care physician before your expenses are covered. If applicable, also ask if you are required to have a copayment ready and whether the substance abuse treatment expenses will apply to a deductible.
How long your substance addiction treatment is covered depends on what your health plan covers. Your health insurance provider may cover the full length of your treatment, while others may agree to cover a set number of days. This can be a challenge if you are required to remain in medical detox for a long time or a residential stay that goes past the 30-day mark.
The duration of your stay in rehab treatment may also be determined by whether you are at a private or public treatment facility. Private facilities can cost more, which means you can reach the maximum treatment limits that are covered faster than you would at a public treatment center.
Still, when choosing a drug or alcohol rehab, you should look for quality, credentials, and treatment plans that have a successful record of treating its clients. Again, if your insurance company does not cover or provide full coverage for the recovery treatment services that you need for a full recovery, Pathway to Hope can help you.
If you do not have health insurance to cover the costs of substance abuse treatment services, you should still give us a call at 954-866-4756. There are options that can connect you with the substance addiction treatment care you need. You may be eligible to receive scholarships or grants to cover your rehab costs, or you can check with social services programs that offer help.
The team at Pathway to Hope works with insurance professionals and advocates on behalf of our clients to maximize available insurance benefits and explore financing options that can ease the burden of paying for addiction treatment.
Don’t join the millions of people who let cost stop them from seeking help that can save their lives from the chronic, deadly disease of addiction. Our specialists are standing by 24/7 to answer your call and provide with the information you need. Call 954-866-4756 now or fill out the form below to verify your insurance.