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Most health insurance plans will cover addiction treatment for alcohol and drug addiction. After the passage of the Affordable Care Act (also known as Obamacare) in 2010, access to substance abuse, addiction, and mental health treatment services increased for people across the nation. Depending on the type of plan one has, coverage options and duration of coverage will vary. If you are unsure about your insurance benefits or want to learn more about coverage options, the team at My Recovery can provide guidance on this, sometimes confusing, process.  

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Understanding Insurance

Does Private Health Insurance Cover Drug Rehab?

For many years, one of the primary concerns boring people struggling with addiction from seeking treatment was insurance coverage or lack of insurance coverage. Unfortunately, paying for addiction treatment remains a significant enough concern, so a limited number of people in need of addiction treatment will seek or receive treatment. Current estimates indicate approximately one out of every ten people who should receive addiction treatment will. Since the passing of the Affordable Care Act, mental illness and addiction treatment have become less stigmatized. Therefore, the ability to obtain insurance or other types of funding to pay for treatment has increased. However, a few insurance companies still present significant hurdles for those suffering from addiction treatment to pass through before they can receive the help they need. 

Before the Affordable Care Act, many insurance companies did not cover substance abuse or addiction treatment of any kind. Many, if not all, insurance companies were able to deny coverage for addiction treatment either entirely or partially to policyholders based on whether their substance use disorder or other co-occurring mental health conditions were considered “a pre-existing condition.”  The Affordable Care Act required many insurance plans to provide coverage for mental and behavioral health services, including substance abuse and addiction treatments. While this was definitely a step in the right direction, how much an insurance company covers for treatment depends on one’s individual plan and the treatment program they choose. Also, in some cases, it is necessary to receive prior authorization or a referral from a primary health care provider before beginning treatment to ensure that insurance will cover the process. In addition to addiction coverage, the Affordable Care Act also mandated that insurance policies cover the treatment of co-occurring mental health disorders such as anxiety or depression. Many people who struggle with addiction or substance abuse disorders also struggle with mental health challenges. Therefore, the Affordable Care Act mandated that treatment medications, therapy, and even time spent in residential inpatient addiction treatment facilities be covered as part of the overall insurance policy. 

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What Does Private Insurance Covering Rehab Entail?

As previously noted, there are sometimes steps one has to take before insurance will cover addiction treatment. In some cases, these steps include a referral from a primary care provider or certain types of diagnostic testing. Some insurance plans cover 100% of detox and treatment expenses once the covered member meets their deductibles. On the other hand, other insurance providers require covered members to pay copayments for each service the facility charges the company for. For example, if someone participates in detox, therapy, medication administration, and aftercare programs, a copayment might be necessary for each one of these services. If you are unsure what your insurance provider will or will not cover, the team at My Recovery can help put you in contact with the right people to better understand your insurance benefits before committing to an addiction treatment facility. Also, insurance companies may require selecting an in-network treatment facility to ensure the highest-paid benefit. Out of network treatment facilities may be utilized; however, this often comes at a higher out of pocket cost. 

Another caveat to private insurance coverage for addiction treatment is the type and extent of treatment the insurance company will agree to cover. Because the detox process varies significantly depending on the individual and the substance they were addicted to, the cost covered by insurance will vary according to the detox process the covered member requires and their individual insurance plan. For example, non-medical detox may be less costly than a hospital-based or a medically supervised detox program. Also, while insurance companies are obligated to offer benefits for substance abuse treatment, they do not have to cover the highest level of care. If someone struggling with addiction can be best served in an outpatient care setting, that is likely with the insurance company will agree to cover. However, if outpatient care is not successful, inpatient care might be deemed medically necessary and therefore covered by the insurance policy. 

Insurance companies will cover addiction treatment services for a specific period. When determining the coverage they provide to a patient they utilize several criteria. The insurance company will likely work with one’s primary care provider or addiction treatment provider to determine the necessary course of treatment before deciding what they will cover and for how long. Because there are multiple levels of care one could seek in addiction treatment, insurance companies may choose to cover one or more possible programs. Some plans may only cover a detox stay. In contrast, others may provide coverage for multiple services as the patient moves through the continuum of care. For example, the insurance company may cover everything from detox through inpatient rehab and outpatient aftercare services. 

Another concern many have when it comes to addiction treatment is whether or not insurance companies will help pay for aftercare services. Although detox and addiction therapies are essential steps towards sobriety and long-term recovery, aftercare remains an integral component of maintaining sobriety. Fortunately, widespread insurance coverage is often available for outpatient treatments and aftercare services. However, there are time limits placed upon these services by many insurance policies, and while some insurance companies may offer policies that cover treatments for up to a year, others may stop coverage after days or a few weeks. It is essential to verify one’s specific insurance coverage with the chosen treatment facility (or look to the team at My Recovery for assistance) before committing to a particular plan of treatment or aftercare program. 

Insurance programs will typically cover evidence-based addiction therapy models. Popular therapy methods used to treat addiction (and many co-occurring mental health disorders) include cognitive-behavioral therapies, family counseling, group therapy, addiction education, and vocational rehabilitation. Because the American Psychological Association approves these treatment models, they are typically covered by most insurance providers. Many addiction treatment centers have begun to offer holistic or alternative treatments as part of their care model. These alternative treatments are offered in conjunction with traditional, evidence-based practices. Unfortunately, not all of these treatments are supported by the American Psychological Association (at this time) and, therefore, may not be covered by most insurance providers. 

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What Are the Types of Private Insurance?

When shopping for insurance on the health insurance marketplace or through an employer, one is often presented with various private insurance options. Many of these can seem quite confusing as they have multiple layers, and each layer affords different benefits. Each insurance company, or insurance brand, may offer one or more of four common types of plans. These include health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPO’s), point of service plans (or POS plans and high deductible health plans, which may be linked to health savings accounts or HSAs.

Each different plan’s inner workings can be quite complicated and a lot to wrap one’s head around. Depending on the specific insurance plan, it is essential to directly contact the insurance provider to ask about addiction treatment benefits. Each program provides different levels of freedom when it comes to choosing health care providers, which doctors you can see, the level of your premium, the amount of your deductible, and the amount of your copays. In most cases, cheaper monthly premiums often equate to higher copays and higher annual deductibles. Each type of plan is also commonly organized by the level of benefits they offer. These levels are usually divided into colors such as bronze, silver, gold, and platinum. Bronze plans generally have the least coverage, whereas platinum plans have the most. In some states, if you are under the age of 30, you may also be able to purchase a high deductible, catastrophic plan that only provides coverage in a medical emergency or catastrophe. 

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Find a Drug Rehab Who Takes My Private Insurance

Many rehabs across the nation take most types of health insurance. However, it is essential to work directly with the insurance company and the rehab center to determine the level of coverage available for addiction treatment based on one’s specific insurance plan. Although the rehab center may take that particular insurance, it does not mean that 100% of the addiction treatment program will be covered by insurance. 

At My Recovery, we can help you work with your insurance provider and your chosen rehab to determine what, if any, out-of-pocket expenses you may have after insurance. Don’t let the financial concerns surrounding rehab keep you from seeking addiction treatment. Let the team at My Recovery help you find a drug rehab that takes your private insurance today.

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