Many people resist treatment for addiction for a variety of reasons, from the stigmas associated with addiction to worrying about the cost of their care. The good news for patients — coverage of mental health treatment, including addiction treatment, has improved greatly over the past ten years.
The Affordable Care Act mandates that all insurance plans on the Healthcare Marketplace cover these services as part of essential health benefits. However, what services are covered and how much cost is covered can vary greatly from insurer to insurer and plan to plan.
Medicaid and Medicare cover addiction treatment services and many private insurance plans, such as the ones you get through an employer or through the Marketplace, follow these same guidelines. Most insurers have realized that covering addiction treatment is much cheaper than covering emergency room visits and other complex care that results from overdoses or complications of addiction.
Though addiction treatment is covered more often and better than before, you will still need to verify with your insurer that these different types of treatment are covered:
Your insurer may have limits on how many “days” of detox or inpatient treatment is covered. They may also require you to pay exorbitant deductibles or co-pays until your out-of-pocket max is met. These are all things you should ask your insurance provider before admitting to a facility. Additionally, your facility can help you navigate these limitations and help you receive the care you need. Many facilities, including Harmony Place will create a treatment plan that helps you use covered services and may offer payment options for services that are not covered, but that you need as part of your recovery.
The most recent trend amongst addiction treatment centers is contracting with insurance companies. Your insurance company may guide you to their in-network providers and only cover costs from these approved facilities. Going to an “out-of-network” provider may result in higher costs and less coverage.
You should be able to find a list of “in-network” providers through your insurer’s website. You can also speak with your insurer about coverage by calling the number on the back of your insurance card. You’ll need to have your insurance ID number (typically on the front of your card) ready so they can give you the most accurate and up-to-date information. Keep notes on your call, including who you talked to in case there is any question regarding coverage down the road.
Thanks to the Mental Health Parity and Addiction Equity Act of 2008, all insurance companies are required to cover mental health and addiction care at the same rates they cover other types of healthcare. This means that you should have the same co-pays and deductibles for addiction treatment services as you do for trips to the doctor for a cold or other health conditions.
Every insurance covers these services in different amounts. You should verify with your insurer and your chosen facility what you will have to pay in:
You may be able to find this information in your Summary of Benefits, which most insurance companies will provide to you online or via mail. If you cannot find this information yourself, you or your provider can contact your insurance company to verify expected costs.
Some insurance companies begin covering services completely once you meet your annual deductible. Before entering treatment, you should verify your facility’s reimbursement policy, especially if you are paying costs upfront. If your insurance company pays for your care after a certain point, you want to ensure that you are reimbursed appropriately.
The same law mentioned above also prevents insurers from discriminating against certain types of substance abuse disorders. Insurers must cover opioid addiction, alcohol addiction, and other addiction exactly the same, with the same services and the same co-pays and deductibles. You can find covered addiction treatment for any type of substance use disorder.
The same is true for mental health disorders. Insurers cannot cover one type of mental health disorder, like depression, and not cover another like bipolar disorder — and many addiction treatment centers will address both conditions at the same time.
Because of changes in healthcare law in 2017 and 2018, insurance companies could begin to offer individual insurance plans that don’t cover addiction treatment or other essential health benefits. These plans are purchased through private insurers directly. To ensure your plan covers detox and addiction treatment, always purchase your health insurance through healthcare.gov or get insurance through your employer, if possible.
You have health insurance for a reason: to get help when you need it most. Don’t be afraid to reach out for help and take the steps you need to improve your health and your life. If you feel overwhelmed navigating insurance information, reach out to your addiction treatment provider or facility for help. They will assist you in making sure you can get the care you need, and understand your financial responsibility for addiction treatment.
At Harmony Place, we accept all PPO insurance plans, as well as some HMO and EPO plans. We will work with you to determine if your care is covered and help you create a financial plan if your insurance does not cover addiction treatment here. Start your insurance verification process online.