For most people struggling with a medical issue or physical complication, relying on your insurance coverage to bear the majority of the financial burden is commonplace.
Dealing with the mental and physical effects of a surgical procedure or medical intervention can be personally overwhelming and monetarily astronomical, so having comprehensive insurance coverage prior to beginning any form of treatment is beneficial on a number of levels.
This sentiment is applicable when discussing rehabilitative services for substance addiction and the importance of having comprehensive insurance coverage prior to initiating any form of outpatient treatment or inpatient stay.
Multiple forms of legislation have been presented and passed over the past decade ensuring that insurance companies provide appropriate coverage for individuals struggling with addiction.
Additionally, these companies must ensure that the coverage provided for rehabilitative services and treatments is comparable to the extent of coverage allotted for general medical issues. 1
The following laws and regulations reinforce the manner in which insurance coverage has expanded in order to adequately address a substance use disorder and the appropriate therapeutic interventions implemented:
- Mental Health Parity and Addiction Equality Act
The Mental Health Parity and Addiction Equity Act of 2008 requires insurance groups offering coverage for mental health or substance use disorders to make these benefits comparable to general medical coverage.Deductibles, copays, out-of-pocket maximums, treatment limitations, etc., for mental health or substance use disorders must be no more restrictive than the same requirements or benefits offered for other medical care.
- Americans with Disabilities Act
The Americans with Disabilities Act (ADA) establishes requirements for equal opportunities in employment, state and local government services, public accommodations, commercial facilities, transportation, and telecommunications for citizens with disabilities—including people with mental illnesses and addictions.
- Affordable Care Act
The Affordable Care Act of 2010 is one aspect of a broader movement toward reforming the health care system. The Affordable Care Act makes health insurance more affordable for individuals, families, and small business owners.People living with mental health challenges or substance use disorders often have problems getting private health insurance. Now there are special insurance protections to help.
Substance Abuse Insurance Coverage
While tremendous strides have been made to ensure the insurance companies adequately cover the expenses associated with substance abuse treatment and rehabilitative services, the manner in which that coverage is doled out can vary from policy to policy.
That is why it is imperative for you to thoroughly review your entire policy prior to beginning treatment in order to understand what your insurance will cover and what they expect you to pay out of pocket.
For example, copays can vacillate between 10-50%, depending on the company providing the services and the types of treatment being received.
Additionally, some providers cover 100% of the cost for an unlimited number of days, whereas others limit the initial approval of treatment coverage to 21 days – requiring clinical progress reports from the facility in order to approve any additional funds. 2
The easiest way to understand which services your policy covers, and for how long they provide that coverage, is to contact your provider directly and discuss your coverage and options prior to beginning your treatment program.
How Long Does Insurance Cover Addiction Treatment?
The time frames for addiction treatment coverage can vary dramatically, but most insurance providers will minimally cover an initial stay of 21 days of inpatient rehabilitative services.
They will require an appropriate diagnostic assessment be completed in order to identify the diagnosable substance use disorder impacting your health, as well as the corresponding clinical recommendations in order to justify your transition into therapy.
Due to the previously mentioned legislation protecting your rights to receive insurance-covered addiction therapy, your time in treatment can be justifiably extended if it is clinically necessary to your overall health and therapeutic progress.
These types of exceptions are reviewed as need be, so working closely with your treatment facility to discuss where you are throughout the treatment process is essential to receiving the proper amount of time in your treatment program.3
Are You Without Insurance Coverage for Addiction Treatment? There Are Other Ways You Can Pay for Rehab:
Having the necessary insurance coverage prior to beginning an addiction treatment program is the ideal method of making sure your assimilation into therapy is as seamless and stress free as possible.
However, if you do not have coverage, there is no reason to abandon hope.
Many treatment facilities offer various methods of financial support to their clientele in order to ensure that they are able to receive the most appropriate therapeutic interventions without falling into debt while achieving their sobriety.
These may include:
- Payment plans tailored to your specific monetary situation
- Employee assistance programs4
- Sliding scale fees based on financial need
- Familial assistance and monetary support
While these options vary per location, looking into any and all available resources when dealing with your health and recovery journey is essential.
Holistic Addiction Treatment at Ranch Creek Recovery
There is no perfect path to achieving sustained sobriety, so preparing for all of the potential pitfalls and roadblocks is the most effective method of maintaining focus and motivation when times become
Offering an alternative to the traditional twelve-step program, Ranch Creek Recovery provides a variety of all-encompassing, holistic in-patient treatment services. Your situation is unique; your treatment must be customized to fit your individual recovery needs.
Our admissions team is standing by and ready to help you uncover viable ways to pay for treatment. You can work to quit your addiction. You can work to turn your life around. We’re here to help.
1 U.S. Department of Health & Human Services. About the Affordable Care Act. Accessed February 5, 2019. https://www.hhs.gov/healthcare/about-the-aca/index.html.
2 Insurance Quotes. Addiction Treatment and Your Health Coverage. Accessed February 5, 2019. http://www.insurancequotes.org/health-insurance/health-resources/addiction-treatment-coverage/.
3 HealthCare.gov. Mental health & substance abuse coverage. Accessed February 5, 2019. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.
4 U.S. Office of Personnel Management. Frequently Asked Questions. Accessed February 5, 2019. https://www.opm.gov/faqs/QA.aspx?fid=4313c618-a96e-4c8e-b078-1f76912a10d9&pid=2c2b1e5b-6ff1-4940-b478-34039a1e1174.