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Insurance Accepted

During the course of a drug addiction, nonstop chaos, unforeseen consequences and utter confusion eventually drive some addicts to seek out treatment help. For many entering rehab, the life they have now looks nothing like the life they lived before drugs took over.

By the time a person decides to enter drug rehab, it’s likely his or her finances have taken a significant beating considering the constant stream of money needed to fund a drug habit. According to Kaiser Health News, in 2012, only 11 percent of 23 million Americans needing treatment actually got help. An inability to cover the costs of treatment accounted for why so many people went without needed treatment help.

For those fortunate enough to have maintained employment and health benefits, finding rehab centers that accept insurance can go a long way towards reducing treatment costs. Though most rehab centers do accept some form of insurance coverage, not everyone manages to hold onto their job and/or health benefits. Fortunately, many rehab centers will accept government-sponsored insurance coverage when a person is unable to afford treatment.

Rehab Center Provisions

paying for rehab

Each rehab center has a different policy about which insurance plans they accept.

Rehab centers vary in a number of ways in terms of –

  • Types of services offered
  • Types of addictions treated
  • Types of insurance accepted
  • Payment assistance options

All of these factors can influence whether a person’s insurance will cover treatment. These factors will also likely influence what percentage of costs your insurance will cover. The types and quality of services offered, such as those offered by luxury-type programs versus state-run programs, have a considerable influence on the overall costs of treatment.

The types of addictions treated may also have a bearing on overall cost depending on the severity of a person’s addiction and the types of treatment protocols used. For example, opiate addiction treatment services differ considerably from those used in amphetamine addiction treatment.

In general, most all rehab centers accept health insurance, though not all may offer payment assistance options. Being able to make payment arrangements in cases where insurance only covers 30, 40 or 50 percent of the overall treatment cost can go a long way towards helping reduce financial strain.

Types of Rehab Centers

Rehab centers can vary in terms of the level of care offered by any one program. These differences will most definitely factor into the cost with most rehab centers providing one or more levels of treatment. Levels of treatment most commonly offered include –

  • Detox services
  • Inpatient care
  • Outpatient care
  • Residential care
  • Sober living homes

While the most intense levels of treatment (detox and inpatient) tend to run shorter in duration, they may still run high in cost simply because of the intensive level of care provided by these programs. Outpatient programs are less intensive, but typically run for long durations so the overall cost can be considerable.

The live-in aspect involved with residential programs also tends to come with a higher price tag considering housing and boarding costs factor in on top of drug treatment costs. The same goes for sober living homes, though payment requirements tend to be more flexible in sober living programs.

Changes In Health Care Law

Recent changes in health care law have opened up the market in terms of the types of services standard health insurance plans cover. These changes have also redefined what’s considered “medically necessary,” which ultimately determines what any one policy plan can cover, according to the Office of National Drug Control Policy.

Through the Affordable Care Act of 2014, addiction treatment is now categorized as a medically necessary form of care. As a result, all insurance carriers must cover rehab treatment as part of their standard benefit offerings. These provisions apply for every type of insurance plan, some of which include –

  • Medicaid coverage
  • Medicare coverage
  • Employer-sponsored plans
  • Individual coverage plans
  • TRICARE

Where once rehab treatment coverage was only available when purchased separately, these fundamental changes in health care law have made rehab treatment benefits available to anyone with standard health insurance coverage.

Mental and Behavioral Health Care Coverage Provisions

Marketplace insurance plans cover 10 categories of treatment, all of which are defined as essential health benefits. According to Healthcare.gov, mental and behavioral health treatment make up two of the 10 covered treatment categories.

This means insurance accepted rehab centers must bill the insurance carrier for any services included under the mental and behavioral health care categories. Standard services covered include –

  • Psychotherapy
  • Counseling
  • Substance use disorder treatment
  • Behavioral health inpatient treatment

These insurance coverages can be of great help throughout a person’s recovery process, since most of the time spent in treatment entails addressing addiction problems through psychotherapy and behavioral treatment work.

Employer-Sponsored Coverage

Before the passing of the Affordable Care Act, employers were not required to cover rehab treatment benefits to the degree that medical treatment benefits warranted. In effect, anyone with an employer-sponsored plan only had limited coverage benefits for rehab treatment care.

With the passing of the new health care law, employers now have to offer equal amounts of coverage for rehab treatment and medical care. Under the “equal benefits amount” provision –

  • Employees can gain access to care management tools
  • Coverage allowances exist for out-of-network health care providers
  • Treatment stay allowances for rehab treatment equal those allotted for medical care in terms of the length of time a person can stay in an inpatient or outpatient program and still be covered
  • Equal coinsurance, copay and/or out-of-pocket requirements and maximums

Government-Sponsored Insurance Options

Government-sponsored insurance options include Medicare for people 65 and older, and Medicaid for low income and disabled individuals. While not all insurance accepted rehab centers will accept Medicaid and Medicare health insurance coverage, many of them do.

With Medicare being a federally funded program, standard coverage allowances apply across the board. On the other hand, Medicaid receives funding from both federal and state governments so coverage allowances can vary from state to state.

Considerations

The type of rehab treatment a person most needs will ultimately determine how expensive treatment costs will be. For this reason, it’s always best to check and see what percentage of rehab center costs your particular policy will cover. Some insurance accepted rehab centers also offer sliding scale payment options and/or financing plans. These options can come in handy when out-of-pocket costs run higher than expected.

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