Navigating the healthcare system in America can be remarkably challenging. Over the past several years, there has been significant changes to health insurance in the United States. According to the government, and laws passed, treatment for substance abuse is supposed to be considered to be equivalent to treatment for a mental health disorder, in the eyes of insurance companies. This means, that insurance companies are often required, depending on one’s coverage and plan, to provide some kind of coverage for one substance abuse treatment.
It is important to keep in mind, that even with laws in place, for some reason this specific coverage seems to still be done at the discretion of each respective insurance company. There are an abundant of treatment programs available, and selecting one that best suits one’s needs is of utmost importance. There will inevitably be some treatment programs and facilities that will not be covered by one’s insurance plan. That said, treatment programs and facilities are not all required to accept insurance. Some treatment programs will not accept any type insurance.
The coverage offered by various health insurances is varied. Furthermore, within each health insurance company, there are many different types of plans available. Each insurance company and plan will have a different premium, meaning amount paid monthly, in return for a range of minimal coverage to extensive coverage. There will also often be a range of copayments associated with health insurance plans. Copayments (copay) regarding one’s substance abuse treatment can vary in cost, depending on the type of the program (inpatient vs. outpatient), medication needed, and in some cases, mental health professionals will also be owed a copay at each visit.
If one’s insurance company and plan does accommodate individuals with a substance abuse problem or addiction, seeking treatment in a hospital may be a good starting point. Many of the inpatient treatment programs that are associated with, or housed in hospitals are, typically, highest on the list of substance abuse treatments that will be covered (partially or fully) by an insurance company. Typically, the copay for this type of treatment would be the same as the expected copay for any other type of inpatient stay at a hospital.
According to the government, all marketplace plans are expected to provide some kind of coverage for substance abuse treatment. Though one’s specific behavioral health benefits will vary, based on one’s state of residence and the specific health insurance plan one chooses. Treatment for drug or alcohol addiction can be one of the items in the fine print of an insurance plan. There are many companies that cover a certain percentage of specific substance abuse treatment, some programs or facilities will be fully covered, and some will not. There may even be some portions that are covered (i.e. detox treatment) and other portions (inpatient treatment) that will be only partially covered. It can be difficult for individuals who are in need of medically assisted substance abuse treatment (i.e. methadone treatment, buprenorphine treatment…etc.) to find an insurance plan or even an insurance company that will provide coverage.
In some situations, certain insurance companies will offer excellent substance abuse treatment coverage. Occasionally, an individual may select to attend a treatment facility or program that does not accept any type of insurance. In this case, the individual will pay the entire cost, out of pocket, him or herself, and his or her insurance company (though it can be a lengthy process) will reimburse some or all of the out of pocket cost.
The literature that goes along with one’s insurance plan can often be loquacious and overwhelming. If there is any confusion, it is best to call one’s insurance company directly and ask any questions one may have to make sure they are answered correctly. Obtaining treatment for substance abuse and addiction is essential. Many substance abuse facilities and programs have a sliding scale regarding fees, and if one’s insurance company does not cover its services, will work with an individual to accommodate his or her needs.
If an individual finds him or herself in a situation where he or she is in need of substance abuse treatment and does not have any type of insurance, there are other options. Some facilities offer its services on a donation based payment, and some are free. It is important for an individual to not let the cost of treatment dissuade him or her from attending treatment. If left untreated, substance abuse and addiction can be extremely dangerous and result in severe long or short term effects.